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A History of Nursing

The Evolution of Nursing Systems from

the Earliest Times to the Foundation

of the First English and American

Training Schools for Nurses

M. Adelaide Nutting, R. N.

Superintendent of Nurses, The Johns Hopkins Hospital ;
Principal of Johns Hopkins Training School for Nurses ;
President of the American Federation of Nurses ; Member of
International Council of Nurses ;

and

Lavinia L. Dock, R. N. '

Member of the Nurses' Settlement, New York; Secretary of the
American Federation of Nurses and of the International
Council of Nurses ; Honorary Member of the Matrons' Council
of Great Britain ^nd Irteland, ?nu ,91 the German Nurses'
Association. ' . \ ;. ;

In Two Volumes

Volume One

111 w s tr ,a f e,v?

G. P. Putnam's Sons

New York and London
Ikntcfcerbocfcer press

^-77 7M*r!7*T rr

a-i- iiiACi^ ft *VUi.

G. P. PUTNAM'S SONS

ALL MEMBERS OF THE
NURSING PROFESSION

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• • ' .,

, " • • •

• • •
. ' •

. • • .

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PREFACE

THE sources, of information relating to the
history of nursing from early times are so
fragmentary, so widely scattered, and, often, so
hidden in material of quite other character, that
it has been practically impossible for the majority
even of those most interested to inform therr «
selves, beyond a meagre general outline, upon
the past of nursing and its conditions .

As a result of this paucity of literature upon the
subject, the modern nurse, keenly interested as
she is in the present and the future of her profes-
sion, knows little of its past. She loses both the
inspiration which arises from cherished tradition,
and the perspective which shows the relation of
one progress: vo movement to others. Only in
the light of history can sl'e clearly see how
closely her own calling is linked with the general
conditions of education and of liberty that obtain
-as they rise, she rises, and as they sink, she
falls.

It has long been the deep desire of the two
collaborators in this work, that the touching and

vi Preface

often heroic history of nursing should not remain
unknown to our modern order. For fifteen years
the one ha,s patiently collected material relating
to nursing and its history, while the other has
devoted her entire time for two years to searching
libraries at home and abroad.

In executing our task, we have been awrare of
our shortcomings, and this the more keenly as we
complete our first volumes; yet perhaps the spirit
of devotion in which we have worked may partly
excuse both the defects that we are conscious of
and possible errors of which we are unconscious.

We have tried, however, to quote only from
authors of recognised authority and to penetrate
as closely to original sources as possible.

Rather than condense Excessively or omit

• i

detail in the earlier chapters1. \v inve thought it

. *

best to stop. on. 't,he threshold 'of -'the ^ modern era,

^ ^

which could not possibly receive justice in two
small volumes. It is our purpose, if this first
effort is well received, to attempt, later, an ac-
count of the j-development of modern nursing, in-
cluding, as it d oeG, important and .d-ra.matic move-
1 • . .

ments in alrrjqstpeyery country, $e£iiaj revolutions

•

in Germany arid France, th'2 awakening of Italy,
and the wonderful'iise of Japan to high eminence.
Our sincere thanks are due to many who have
assisted us, among whom we must especially
mention Dr. Robert Fletcher of the Army Medical
Museum in Washington, the Sisters of St. Joseph
in. Montreal, and the Sisters of the Hotel-Dieu of

Preface vii

Quebec. We wish also to record the cordial and
generous response made by all of those medical
men whose writings we have utilised.

M. A. IsL
L. L. D.

August, 1907.

EGYPT

BABYLO

THE JEWi

GREECE

VOL. I.

in-

CONTENTS

PART I: PRE-CHRISTIAN PERIOD

PAl

PAGE

INTRODUCTION

CHAPTER I
'FIRST AID" AMONG ANIMALS ... 9

CHAPTER II

CARE OF THE SICK OF PRIMITIVE MAN . . 12

CHAPTER III
INDIA 26

CHAPTER IV
CEYLON ....... 42

CHAPTER V

EGYPT . ...... 47

CHAPTER VI

BABYLON AND ASSYRIA ..... 56

CHAPTER VII
THE JEWS 6l

CHAPTER VIII

GREECE ....... 67

VOL. i, ix

Contents

PAGE

CHAPTER IX

ROME 8

PART II: FROM THE FIRST TO THE CLOSE OF THE
EIGHTEENTH CENTURY

CHAPTER I

WOMEN WORKERS OF THE EARLY CHURCH . . 95

CHAPTER n

EARLY HOSPITALS AND THE ROMAN MATRONS . IlS

CHAPTER III
THE RISE OF MONASTICISM .... 144

CHAPTER IV

THE MILITARY NURSING ORDERS . . IJl

CHAPTER V
A GROUP OF SAINTS . . . 2IO

CHAPTER VI

HOSPITALS AND NURSING APPLIANCES 233

CHAPTER VII

RISE OF THE SECULAR ORDERS: THE F, KGUINES,

SANTO SPIRITO, DELATES OF FLORENCE 257

CHAPTER VIII

THE NURSING SYSTEMS OF TWO FAMOUS HOSPITALS

OF PARIS AND LYONS . >. . 281

CHAPTER IX
LATER MEDIAEVAL ORDERS . . 336

Contents xi

PAGE

CHAPTER X

FRENCH AND SPANISH HOSPITALS IN AMERICA . 355

CHAPTER XI

ST. VINCENT DE PAUL AND THE SISTERS OF

CHARITY ...... 404

CHAPTER XII
EARLY ENGLISH NURSING .... 441

CHAPTER XIII

MEDIEVAL SURGERY AND MEDICAL TREATMENT . 477

CHAPTER XIV
THE DARK PERIOD OF NURSLNG . -. . 499

CHAPTER XV •

THE PRE-FLIEDNER MOVEMENTS OF PHILANTHROPY

AND NURSING .... 525

ILLUSTRATIONS

PAGE

HYGIEIA .... Frontispiece

DOMESTIC MEDICINE CHEST OF EGYPTIAN QUEEN 50
AN EGYPTIAN PRINCE AND HIS NURSE . . 56
HYGIEIA AND ASKLEPIOS .... 68
THE ABATON AT EPIDAUROS . . . -72
THE ECCLESIASTICAL VIRGINS . . . 108

THE SEVEN WORKS OF CHARITY . . .122
VISITING THE SICK ..... 144
ANCIENT COSTUME OF ABBESS . . 148

FORTRESS OF THE KNIGHTS HOSPITALLERS . 172
SISTER OF ST. JOHN OF JERUSALEM . . 180

THE SAME IN CHOIR VESTMENTS . . . 182
GRAND MASTER OF ST. JOHN OF JERUSALEM . 184
KNIGHT OF ST. LAZARUS, 15™ CENTURY . 194

HOSPITAL OF KNIGHTS IN VALETTA . . 208

SISTER OF ST. FRANCIS, THIRD ORDER . . 218
ST. ELIZABETH OF HUNGARY . . . .220
LEGENDARY REPRESENTATION OF LEPERS . 228
OLD CLOISTER HOSPITAL IN RAVENNA . . 232
DETAIL OF MILAN GENERAL HOSPITAL . . 236
HOTEL DIEU OF ANTWERP .... 238

V1V Illustrations

PAGE

HOSPITAL IN GRANADA . 240

HOSPITAL IN ROTHENBURG 242

FRESCO IN THE SIENA HOSPITAL 246

BEGUINAGE AT GHENT , 258

AN ANTWERP BEGUINE . . 262

HOSPITAL IN BEAUNE . , 268

SISTER OF ST. MARTHA . 272

HOSPITAL DRUG ROOM AT BRUGES . 274

SISTER OP THE HOLY SPIRIT . 276

HOSPITALLER OF HOLY SPIRIT, IN CHOIR ROBES 278

SISTER OF THE HOTEL DIEU IN PARIS 294

HOSPITALLER OF HOTEL DIEU IN PARIS . . 298

SCENE IN THE HOTEL DIEU i\ PARIS . 300

SISTERS WASHING LINEN IN THE RIVER 302

A WARD IN THE HOTEL-DIEU OF PARIS . 312

PROCESSION IN THE HOTEL-DIEU OF PARIS 320

SERVING MEALS IN THE HOTEL-DIEU OF PARIS 328

ST. MARTHA WARD HOTEL-DIEU OF PARIS 334

ST. JOHN OF GOD . ... 338

THE MISERICORDIA TAKING PATIENT TO HOS-
PITAL . . 342

HOSPITAL SISTER OF DIJON . . . 346
THE LADY AS PHYSICIAN . . .348
LADIES SERVING THE POOR IN CHARITE . -35°

HOTEL-DIEU OF QUEBEC IN 1816 . 372

Illustrations xv

PAGE

PORTRAIT OF JEANNE MANGE 384

STATUE OF JEANNE MANGE 400

HOSPITAL OF JESUS, CITY OF MEXICO, FOUNDED

BY CORTES . . 402

HOSPITAL OF JESUS, CITY OF MEXICO, ANOTHER

VIEW . 404

ST. VINCENT DE PAUL . ... 410

LOUISE LE GRAS . , 420

SISTER OF CHARITY ..... 426

SISTER OF CHARITY BANDAGING A PATIENT . 434

INFIRMARIAN OF ST. ALBAN'S . . . 444

ST. BARTHOLOMEW'S CRYPT AND GATE . . 456

RAHERE'S WARD . ... 466

COSMOS AND DAMIAX VISITING A PATIENT 478

COSTUME OF THOSE VISITING CONTAGIOUS CASES 498

PART III.

From the Close of the Eighteenth Century
to the Development of Modern

Nursing

PART I
PRE-CHRISTIAN PERIOD

VOL. I.— I.

m OPEHTY OF THt

% -'

A HISTORY OF NURSING

INTRODUCTION

THE art of nursing, at once the oldest of the
occupations of women and the youngest
branch of medical science, must have been co-
existent with the first mother who performed for
her little ones all those services which made it
possible for them to live and thrive. The daily
and hourly details of feeding, warming, and pro-
tecting from harm, the watching by night, the
rhythmical swing of cradle or bough under the
mother's eye — these maternal cares, as old as or
even older than the human race, laid the foun-
dation from which our profession of nursing has
developed to its structure of to-day.

In studying the origin of traits and customs, it
is necessary to consider not only the human family,
but also the far older races of birds and mammals
among which arose the first dawning traces of
parental love, kindness, and mutual aid ; for re-
searches into the history and evolution of man
must remain incomplete unless they are closely

4 A History of Nursing

connected with studies of those lower orders of
creation to which he is related. Primitive peo-
ples have always credited the birds with the pos-
session of a knowledge vaster than that of man,
and surely no one can study their migrations and
flights, their marvellously constructed nests, the
care of their little ones, and the purity and
sweetness of their family life, without wonder and
admiration. The well-developed and intelligent
quality of mother love and care in the higher
animals is well known to every observer, often
appearing, indeed, as far as one can judge by their
actions, in no way inferior, while it lasts, to the
love of the primitive mother for her babe. It
differs only in duration, for the solicitude of the
animal or bird mother for her young ceases with

their maturity.

In seeking the origin of those gentler and more
humane qualities which make a society possible,
most students trace them to the earliest mani-
festations of maternal or paternal love; and the
theory advanced by John Fiske,1 that the superior
progress of the human race is due to the long
period of time during which the human infant is
helpless and dependent, thus evoking a prolonged
and enduring tenderness in the parents, with
the resultant superior development of character,
is commonly regarded as one of his most important

i "On the Part Played by Infancy in the Evolution of Man,"
in A Century of Science and Other Essays by John Fiske,
Houghton, Mifflin & Co., 1899, pp. 100-121.

Introduction 5

contributions to modern thought. Again, other
writers have traced the origin of kindness and
gentleness to the earliest attractions of sex, and
instance the life-long pairing and fidelity of some
birds and mammals as proofs of the more enduring
quality of this form of affection. There is, finally,
ages back in the history of our primal ancestry,
still another impulse, even more widespread and
lasting, and far less personal or individualistic
than either of those already mentioned; namely,
the social instinct or feeling which is clearly the
rudiment of what we call altruism or humanitari-
anism in the human race. This is the instinct of
mutual aid, actually a sense of race preservation,
which prompts the protection of the younger and
weaker of the herd by the older and stronger, and
causes flocks to share the distress or attempt the
rescue of the individual in peril.

To Kropotkin, whose scientific knowledge is
equalled by his benevolence toward all created
beings, we owe the elucidation of this truth, which
he expounds most fascinatingly in his Mutual
Aid.1 In the introduction he relates his own
observations of animal life in the vast regions of
Northern Asia, and gives his reasons for holding
as erroneous the pessimistic views current as to
the •' struggle for existence. ' "In all these
scenes of animal life which passed before my
eyes, ' he writes, " I saw Mutual Aid and Mutual

1 Mutual Aid a Factor of Evolution, by Peter Kropotkin.
Wm. Heinemann, London, 1902.

6 A History of Nursing

Support carried on to an extent which made me
suspect in it a feature of the greatest importance
for the maintenance of life, the preservation of
each species, and its further evolution.' He
quotes another Russian scholar, Professor Kessler
of St. Petersburg, who in iSBo lectured on this
subject and pointed out that 'beside the law of
Mutual Struggle there is in Nature the law of
Mutual Aid, which . . . for the progressive
evolution of the species is far more important
than the law of mutual contest. '

Kropotkin's observations convinced him that
those animal tribes whose members assist each
other the most have survived the most extensively
and are the most capable of survival, and the
theory that competition is the predominating
law of life, and the ' struggle for the means of
existence, ... of every man against all
other men, 'a law of Nature,' . . . lacked
confirmation from direct observation. ' The ex-
istence of this habit of mutual aid, he shows
further, is also true of primitive peoples. Lum-
holtz, a missionary in North Queensland, in
answer to questions put to him by the Paris An-
thropological Society, said of the natives : The
feeling of friendship is known among them: it is
strong. Weak people are usually supported; sick
people are very well attended to; they never are
abandoned or killed." * Other testimony given to

1 Mutual Aid a Factor of Evolution, by Peter Kropotkin.
Wm. Heinemann. London, 1902, p. 92.

Introduction 7

the same society regarding the Papuas of New
Guinea described them as "sociable and cheerful;
they laugh very much. . . They take care of
the ill and the old."1 Feuds, adds Kropotkin,
" are more the result of superstition and ignorance,
than of competition. When any one falls ill, the
friends and relations come together and discuss
who might be the cause of the illness. All possible
enemies are considered, every one confesses his
own petty quarrels, and finally the real cause is
discovered. An enemy from the next village has
done it, and a raid on that village is decided on. '
Of the Dyaks of Borneo he says: ' They are very
sociable, show great respect to their wives, and are
fond of their children; when one of them falls ill
the women nurse him in turn.'

' Historians and annalists, ' says Kropotkin,
."have chronicled wars and calamities, but have
paid no attention to the life of the masses or the
countless acts of mutual support and devotion. '

In attempting to study the history of nursing,
which must always have existed in some form,
however rude, we find long ages of silence on the
subject, doubtless because of this tendency of
historians to overlook what was usual and homely.
During centuries of the time when some sort of
chronicles recorded human progress, there is no
mention of nursing as differentiated from empiric
medicine. Thus, although we may feel certain

1 Mutual Aid a Factor of Evolution, by Peter Kropotkin.
Wm. Heinemann, London, 1902, p. 93.

8 A History of Nursing

that some woman always watched beside the
sick-bed, our first chapters take us directly to
the earliest known methods of practical medicine.
There was, without a doubt, an age so remote that
medicine and nursing were united in one, and even
to-day the Germans describe under the head of

'Nursing' all manner of procedures and treat-
ment which might equally well be placed under

'Medicine' or Treatment.' In the primitive
modes of treatment and the application of rem-
edies now to be seen among savage tribes, no
matter whether this treatment is carried out by
sorcerers, priests, doctors, or old women, we find
examples of the historic ancestry of modern
nursing and the earliest forms of the art, but first
of all we may consider our lowly ' brothers, ' as
St. Francis has called the animals.

CHAPTER I

"FIRST AID" AMONG ANIMALS

NATURAL history, says Berdoe,1 gives abun-
dant proof that the lower animals subject
themselves to appropriate medical and surgical
treatment when necessary, and that they not only
treat themselves when injured or ill, but also assist
each other. Every one has seen cats and dogs eat
grasses and leaves which act as emetics and pur-
gatives. Toads and certain larger animals are
acquainted with antidotes for poisonous spider
and snake bites. All animals show at times a
craving for salt, and will go long distances to get
it. It acts on them as an aperient, and Berdoe
says, "If man had not yet learned the medicinal
properties of salt he could discover them by the
greedy licking of it by buffaloes, horses, and
camels. '

Animals lick their wounds, and this earliest
and most primitive form of antiseptic dressing is
also a natural instinct of man, even in his civilised
state. Apes know how to stop bleeding by com-

1 The Origin and Growth of the Healing Art, Edward Berdoe.
Swan, Sonnenschein & Co., London, 1893, p. 3.

io A History of Nursing

pression vith their fingers, or with pads of leaves
or grass. Rats have been known to gnaw off
(amputate) the leg of one of their community who
was entrapped, to allow it to escape. Certain
birds, notably the snipe, know how to treat
fractures of the l^g, and there are on record
numerous instances in which they have applied
splints, binding them with grasses put on in a
spiral form, and fastening these with a gluey
substance or with clay, and have dressed wounds
with feathers and moss stuck together with co-
agulated blood. 1 Wounded deer have been known
to travel great distances to reach streams or lakes
in order that they might lie with the inflamed
wound in the water, and the German revival in
the last century of the treatment by wet com-
presses for certain classes of wounds is said to
have been started by a German forester, who,
noticing this habit of the deer, concluded that it
might also be good practice for human beings.
Though a layman, he tried the plan, which was
later taken up by German surgeons under the
name of the Priessnitz treatment. Bees display
much knowledge of the laws of sanitation and
hygiene. They ventilate their hives, and enclose
the dead which they cannot carry from the hive
in a close air-tight covering.

Those wTho wish to carry their inquiries further
along this line can find sources of interesting infor-
mation which open up the subject of mental

1 Berdoe, op. cit., pp. 4, 5.

"First Aid" among Animals n

qualities in animals in a most fascinating manner.
Whether one chooses to call it instinct, thought,
or inherited memory, the fact remains that an-
imals have acquired much practical knowledge
of what is good for them, and it is no less true that
man also possesses an intuition which guides him
in the selection of natural remedies, until he loses
or destroys this instinct by abnormal habits or
by over-civilisation.

CHAPTER II

CARE OF THE SICK OF PRIMITIVE MAN

THE intuitive knowledge of what makes for
health, the common heritage of plant and
animal life, with the gradually accumulated ex-
perience of the elders handed down by tradition,
must have been for long ages the only sanitary
guide of primitive man. Our earliest forefathers,
constantly exposed to the attacks of wild beasts,
must have soon learned methods, crude though
they may have been, for the quick and ready
handling of wounds. They were the first surgeons.
The women must have possessed some rude
elementary principles for the care of their children,
and the grandmothers, one cannot doubt, gathered
herbs and made teas pretty much as they do
to-day. Who, that knows the old women of re-
mote mountain regions, can but be certain that
the grandmothers were the first doctors and nurses
thousands of years ago?

As primal man progressed in his power of receiv-
ing impressions, his close intimacy with a Nature
which he knew without comprehending coloured all
his ideas in a way which, though we now call it su-

Care of the Sick of Primitive Man 13

perstitious, was in reality most natural and logical.
Few modern men hch/e sufficient imagination to
put themselves in the position of our earliest
ancestors, who felt the cold, the wind, and the
heat of the sun ; who heard the thunder and the
roar of waters; who saw the flowers spring from
the earth and the fledglings burst their shells
without possessing the slightest inkling of that
knowledge of natural science which every one
breathes in in the air to-day. He felt himself to be
alive; what could he think but that everything
was alive? As he saw in others and felt in him-
self the ;'soul' (psyche, anima, or however it
may be called) , so all things he thought must have
soulo. In dreams the 'soul' was active inde-
pendently of his body, and as in dreams he saw
and handled his weapons, his dogs, his booty, so
must their souls also be capable of leaving their
material forms. Berdoe says:1

There is no doubt that the belief in the soul and
in the existence of the spirits of the departed in
another world arose from dreams. When the savage
in his sleep held converse, as it seemed to him, with
the actual forms of his departed relatives and friends,
the most natural thing imaginable would be the
belief that these persons actually existed in a spiritual
shape in some other world than the material one
in which he existed. Those who dreamed most
frequently and vividly, and were able to describe
their visions most clearly, would naturally strive to

1 Berdoe, op. cit., p. 9.

1 4 A History of Nursing

interpret their meaning, and would become, to their
grosser and less poetic brethren, more important
personages, and be considered as in closer converse
with the spiritual world than themselves. Thus,
in process of time, the seer, the prophet, and the
magician would be evolved.

These simple but logical beliefs were doubtless
strengthened and confirmed by the actual ex-
perience of illness. Every one knows how dif-
ferent a sick person is from his usual self. What
must an untutored mind think of delirium, of a
convulsion, or a chill?

Baas, in his history of medicine, surveying the
progressive thought of primitive man as regards
sickness, says that in the lowest known stage of
development illness was believed to be caused
by some other person — an enemy, or perhaps a
witch (an old woman). In this stage of mental
evolution there was no conception of magicians
nor any beginning of a medical caste. The next
higher plane of mental capacity is marked by the
theory that sickness is caused by spirits, and a
third, still higher, intellectual stage is that which
postulates special gods of healing, with inter-
mediary priests, who are possessed of a knowledge
of medicine. l The second stage, which is still
found in full activity among many Indian and
South Sea tribes, develops the medicine-man or

1 Grundriss der Geschichte der Medizin, by Dr. Johann
Hermann Baas, p. 8. Verlag von Ferd. Enke, Stuttgart
1876.

Care of the Sick of Primitive Man 15

magician (" medicine," among the Indians, mean-
ing anything great, mysterious, or wonderful),
who assumes a spiritual mastery over the disease
demons and pretends by rites and incantations to
be able to expel them from the suffering body.
His methods are: to try to make the patient's
body an unpleasant dwelling-place for the spirit,
and to drive him out by pummelling, squeezing,
beating, and starving; by hideous noises, evil
smells, and nauseous doses ; or he persuades it to
go into some other creature's body to take up its
abode. *

Withington suggests the possibility that the

practice of massage originated in this pummelling,

and also traces the still prevalent belief in

'strong" medicines to its origin in this stage of

race childhood.

Tylor, in discussing the phenomena of sickness
among primitive tribes, says:

As in normal conditions the man's soul, inhabiting
his body, is held to give it life, to think, speak, and
act through it, so an adaptation of the self- same
principle explains abnormal conditions of body and
mind by considering the new symptoms as due to the
operation of a second soul-like being, a strange spirit.
The possessed man, tossed and shaken in fever, pained
and wrenched as though some live creature were
tearing and twisting him within, pining as though it

1 Medical History from the Earliest Times, Edward Theodore
Withington, M.A., M.B., Oxon. Scientific Press, London,
1894, pp. ii, 12.

16 A History of Nursing

were devouring his vitals day by day, rationally
finds a personal spiritual cause for his sufferings.
In hideous dreams he may even sometimes see the
very ghost or nightmare fiend that plagues him . . .
such a one seems to those who watch him, and even
to himself, to have become the mere instrument
of a spirit which has seized him or entered into
him. . . .

This is the savage theory of demoniacal possession
or obsession, which has been for ages, and still remains,
the dominant theory of disease and inspiration among
the lower races. . . . When we have gained a clear idea
of it in this its original home we shall be able to trace
it along from grade to grade of civilisation, breaking
away piecemeal under the influence of new medical
theories, yet sometimes expanding in revival, and,
at least in lingering survival, holding its place into
the midst of our modern life. . . . Disease being ac-
counted for by attacks of spirits, it naturally follows
that to get rid of these spirits is the proper means
of cure

Thus the practice of the exorcist appears side by
side with the doctrine of possession, from its first
appearance in savagery to its survival in modern
civilisation, and nothing could display more vividly
the conception of a disease or a mental afflic-
tion, as caused by a personal spiritual being than
the proceedings of an exorcist who talks to it, coaxes
or threatens it, makes offerings to it, entices or drives
it out of the patient's body, and induces it to take
up its abode in some other.1

i Primitive Culture, by Dr. E. B. Tylor, Murray, London,
1871, vol. ii., pp. 113, 114.

Care of the Sick of Primitive Man 17

Many medical writers have emphasised the
impressive nature of the fact thus noted, that the
earliest religious rites of man arose, not over
abstract moral ideas, or the questions of a future
life, but through the afflicting reality of sickness
and disability, which must have been to our
ancestors the worst of calamities. Andrew Lang
says, 'Untutored people invariably confound
medicine with magic. " l The sick-bed was the cra-
dle of the earliest and most tenacious superstitions,
which even to-day resist the light of true knowledge
and break out periodically in the delusions of
"healers " and the credulity of the masses toward
all forms of quackery. The persistence of the
theory of demoniacal possession has indeed had a
most melancholy effect on the later history of
mankind. It has had its periods of diminution
and recrudescence, the former being more marked
under polytheism and the latter under mono-
theism. In ancient Greece and Egypt the treat-
ment of the epileptic and insane was not only
humane, but was largely remedial, and the general
feeling toward ' witches ' was one of veneration
and awe, not of detestation. This was also true of
the ancient Teutons, who revered their "wise
women. '

The Middle Ages witnessed an acute revival of
the belief in malign spirits, which was chiefly
manifested in relation to many forms of illness.

1 Custom and Myth, Andrew Lang. Longmans, Green & Co.,
London, 1885, p. 148,

VOL. I. 2.

i8 A History of Nursing

*•' t •

Through its influence the already miserable lot
of the leper was often made still more miserable,
and the mentally afflicted, the most pitiable of
all human sufferers, were at many periods and in
many places believed to be possessed of devils and
treated with incredible cruelty, even up to the
very dawn of the nineteenth century. Their
history forms one of the most tragic chapters in
the whole course of human misery.1

Another almost incredible result of this mon-
strous superstition, based on the mysteries of
health and sickness, was the persecution of
witches. Alexander, an old-fashioned but free-
thinking physician, in speaking of the extreme
antiquity of the belief in witches, notes the fact
that witches were usually feminine, and old. 2
He thinks it difficult to say why, but it seems
obvious that the ancient women of early tribes
who went out early and late to gather the herbs of
which they, more than others, knew the medicinal
and remedial secrets, must have been the earliest
prototypes of the witch of legend and myth.
Nor is it hard to understand how a superstitious
feeding might have grown up towards them, for,
while the expression of an old man is usually
feeble and benign, there is often something truly

1 See History of European Morals, William E. H. Lecky,
M. A. D. Appleton Co., New York, 1897, vol. ii., pp. 86-90.

2 Tlie History of Women from Earliest Antiquity to the
Present Time, William Alexander, M.D. C. Dilly, London,
1782, p. 71.

Care of the Sick of Primitive Man 19

weird and appalling in the aspect of ^n old*

woman.1

Witches were believed to have the power of
causing wasting sickness or other harm by a look
(the evil eye, still firmly believed in in man^
regions), or by making little images of the victim,
or by procuring something which had been^part
of the victim's body, as a hair, some nail parings,
etc. Many familiar superstitions derived from
this belief are to be found to-day. The epidemics
of witch-burning, which disgr^cl! European civ-
ilisation and even our own, are too well known
to recount. In the county of Essex, England,
alone, sixty witches were burnt in one year, and
Dr. Zachary Grey mentions seeing a list of be-
tween three ancTTbur thousand witches who had
been killed, either by drowning or burning, with
cruel tortures. No more remarkable psycholo-
gical study is possible than that afforded by the
writings of Increase Mather,2 on the hideous
insanity which persecuted and burned as witches
a number of harmless young and old women in
Salem in 1692. His book might well be termed
'A Study in Indigestion;" for the profound
melancholy which he describee as the device of
the devil ("Balneum Diaboli," the devil's bath),
saying, "It is confessed that Satan does take

1 Mason notes this in Woman's Share in Primitive Culture,
p. 256.

^Remarkable Providences, by Increase Mather. Reeves &
Turner, London, 1890, p. 7.

20 A History of Nursing

great advantage from the ill humours and diseases
which are in the bodies of men greatly to molest
their spirits," 1 could only have been caused by
prolonged and malignant indigestion. " He who
dared to doubt the appearance of ghosts, witches,
and goblins, and their power to torment man ;
and the power of the priesthood over these mys-
terious tormentors was denounced as an infidel, '
writes Offer in his preface to this most gloomy
and horrible of all psychological revelations.
The belief in witches and their power to induce
sickness in man or beast is still found in remote
country regions and among uneducated people.
Indeed a demand for a trial for witchcraft was
recently made in Pennsylvania.

As the caste of medicine-men developed there
was always to be found associated with them an
inferior or empirical class of practitioners, who
applied the treatment, ascertained the qualities
of drugs, became skilful in dressing wounds, in
nursing, and even in abating fevers.2 These
were often, or perhaps always, as Mason sug-
gests, the women of the tribes, with their practi-
cal knowledge of drugs and appliances.3 The
medicine-men, \vho doubtless themselves had a

1 Remarkable Providences, by Increase Mather, Reeves &
Turner, London, 1890, p. 186.

2 Woman's Share in Primitive Culture, Otis Tufton Mason,
A.M., Ph.D. D. Appleton & Co., New York, 1894, p. r 50.

3 "The first empiric physicians were not the Sorcerers, but
the Herb women. They gathered the first Materia Medica."
Ibid., p. 278.

Care of the Sick of Primitive Man 21

good knowledge of herbs, including poisons,
cultivated an air of dignity and reticence, as-
sumed wisdom, and spoke in a language not
understood by the laity. A point that is not clear
from the nursing standpoint is the exact relation
of the sorcerer and the empirical associate to each
other. If the old woman or other assistant
received from the medicine-man orders for the
treatment of the patient, then the relation was
that of physician and nurse. If on the other hand
the attendant (man or woman) prescribed the
baths and herbs while the sorcerer limited himself
to incantations, then the two may be regarded
as symbolising the theory and practice of medicine,
the latter including the yet unspecialised depart-
ment of nursing.

The difference between a baleful and a bene-
ficent use of knowledge was early recognised and
distinguished by the terms "black" and 'white"
magic. This distinction lasted through the Middle
Ages. Thus the mythology of Finland, which is
very ancient, alludes to the two classes — there
were those who practised 'white magic" by
means of learning and benevolence, and those
who practised ' black magic ' with the aid of evil
spirits, poisons, and malice. The magic of Fin-
land was largely medical. 1

The practical nursing among savage tribes, so
far as certain kinds of treatment go, is not to be
despised. Many can dress wounds, rub and

1 Berdoe, op. cit., p. 15.

22 A History of Nursing

apply friction and counter-irritation skilfully,
and reduce fever with drinks and applications of
water. All savage tribes have a good knowledge
of massage (as for instance the lomi-lomi of the
Sandwich Islanders), and the old women are
familiar with hot fomentations and their uses,
and know how to make many diaphoretic and
relaxing teas and brews. The use of the s weal-
bath is well known to them and is importani .
The omnipresent sweat-house of the aborigines is
thus described by Smith l :

Sometimes they are troubled with dropsies, swell-
ings, aches, and such like diseases; for cure whereof
they build a Stoue in the forme of a Roue-house with
mats, so close that a few coales therein, covered
with a pot, will make the patient sweat extremely.

Before going into the dance the men, or at least
the leaders, fasted for twenty-four hours, and then
at sunrise entered the sweat-house for the religious
rite of purification preliminary to painting them-
selves for the dance. The sweat-house is a small
circular framework of willow branches driven into
the ground and bent over and brought together at
the top in such a way that when covered with blankets
or buffalo robes the structure forms a diminutive
round top tipi just high enough to enable several
persons to sit or stand in a stooping posture inside.
The doonvay faces the east, as is the rule in Indian
structures, and at the distance of a few feet in front

1 \T)th Antiual Report of the Bureau of Ethnology, by I. W.
Powell. Washington. 1896, p 19.

Care of the Sick of Primitive Man 23

of the doorway is a small mound of earth, on which
is placed a buffalo skull, with the head turned as
if looking into the lodge. The earth of which the
mound is formed is taken from a hole dug in the
center of the lodge. Near the sweat- house, on the
outside, there is frequently a tall sacrifice pole, from
the top of which are hung strips of bright-colored
cloth, packages of tobacco, or other offerings to the
deity invoked by the devotee on any particular
occasion.

The sweat- bath is in frequent use, both as a re-
ligious rite of purification and as a hygienic treat-
ment. Like everything else in Indian life, even the
sanitary application is attended with much detail
of religious ceremony. Fresh bundles of the fragrant
wild sage are strewn upon the ground inside the sweat-
house, and a fire is kindled outside a short distance
away. In this fire stones are heated by the medicine-
men and when all is ready the patient or devotee,
stripped to the breech-cloth, enters the sweat-house.
The stones are then handed in to him by the priests
by means of two forked sticks, cut especially for the
purpose, and with two other forked sticks he puts
the stones into the hole already mentioned as having
been dug in the center of the lodge. Water is then
passed in to him, which he pours over the hot stones
until the whole interior is filled with steam; the
blankets are pulled tight to close every opening, and
he sits in this aboriginal Turkish bath until his
naked body is dripping with perspiration. During
this time the doctors outside are doing their part in
the way of praying to the gods and keeping up the
supply of hot stones and water until in their estima-

24 A History of Nursing

tion he has been sufficiently purified, physically and
morally, when he emerges and resumes his clothing,
sometimes first checking the perspiration and inducing
a reaction by a plunge into the neighbouring stream.
The sweat- bath in one form or another was com-
mon to almost every tribe in the United States, but
as an accompaniment to the Ghost dance it seems
to have been used only by the Sioux. The Ghost
dance sweat- house of the Sioux was frequently made
sufficiently large to accommodate a considerable
number of persons standing inside at the same time.1

Bleeding and cupping for the relief of pain are
both practised in savage tribes. The Indians open
abscesses with sharp flints, and amputate limbs
with hunting knives, checking the hemorrhage
with hot stones. 2 The remains of prehistoric
man show skulls of the neolithic age that have
been trephined,3 and the South Sea Islanders
practice trephining now. There are tribes in
Australia that perform ovariotomy, and an Eng-
lish traveller has seen a Caesarian section per-
formed by a native of Central Africa4 Perhaps
one of the most interesting of all of the discoveries
of primitive man in the realm of practical medicine
is that of the inoculation for small-pox, which has
been known to certain savage tribes since time
immemorial. Livingston and Bruce have re-

Annual Re-port of the Bureau of Ethnology. Washing-
ton. 1896, part i., pp. 822-823

2 Berdoe, op. cit., p. 42.

3 Withington, op. cit., p. 7.
* Berdoe, op. cit., p. 45.

Care of the Sick of Primitive Man 25

ported that the Hottentots and other tribes of
Central Africa have this knowledge, and that in
Nubia it has been practised by old negresses from
remote antiquity. But, efficient as savages are
in many ways in meeting the conditions of their
lives, we have only to know of the condition of
the sick in the huts of the Laplanders, the cots
of the Irish peasant, and the cabins of moun-
taineers to realise how far from providing even
the most elementary conditions of comfort for the
sick were the primal forms of nursing and
medicine.

CHAPTER III

INDIA

WE have seen that the earliest thoughts of
primitive man personified all that he saw in
nature; that, to his simple and objective mind,
even material objects were animate with a life
similar to his own ; that the phenomena of nature
were his greatest mysteries, and that his first
mystic rites clustered about the treatment and
cure of illness and the preservation of health, the
chief of blessings. Hence, it is a logical sequence
to find that nature-worship was the basic principle
on which the mythologies and religions of the
ancient civilisations were founded. The many
gods of ancient times, so innumerable, bewildering,
and often repulsive when regarded without the
key to their meaning, are simple and real when it
is remembered that they were all originally nature
gods, or simply external forces of nature or attri-
butes of the physical and intellectual man sym-
bolised and personified.

There is no more fascinating study than com-
parative mythology, wherein one learns to recog-
nise the nature-myths of different lands as the
same, with only the differences of names or such

India 27

details as are due to variations of climate or the
physical conditions of the earth. The sun, early
recognised as the source of all energy ; the sea with
its mysterious depths; the still more inexplicable
interior of Mother Earth, from which issued
volcanic fire and pure springs of water; the death
of winter and the resurrection of springtime; the
generative power evident in all nature — all were
objects of veneration, worship, and personifica-
tion. Examples of this personification still
exist in fairy tales.1 It is quite indispensable to
remember this if one wishes to interpret rightly
medical myths and the close relation of ancient
medicine to mythical deities. It is not easy for
modern folk, who have so largely separated their
religion from their daily practical life, to realise
how closely related to every act of life nature-
worship must have been. The occupation of agri-
culture developed the loveliest and most poetic
side of the old myths; the study of sickness, with
its resultant demonology, led at times to the
gloomiest and most dreadful. Of old, as to-day,
the progress of medical hierarchies came through
the patient study of nature, and an ever growing
practical acquaintance with her laws and truths
steadily contributed to the enlightenment of the
priest-physicians. The union of theory and prac-
tice still continued to be typified in the orders
of priest-scientists, of whom one took' the more

]Red Riding Hood, the Sleeping Beauty, all dragon
stories, are summer and winter or day and night myths.

28 A History of Nursing

religious, the other the more practical duties of
the healing art.

Through the researches of modern scholarship,
the deciphering of ancient records, and the ex-
cavation of long buried cities of early civilisa-
tions, floods of light are being thrown into the dim
vistas of history, and in this light the people of
antiquity appear before the student, no longer as
shadows or as pictures cut in a rock, but as human
beings of intimate acquaintance and naturalness.
No longer strangers or aliens, the ancient Hindoo,
Egyptian, and Greek are seen to have had the
same works of mercy, the same impulses of
humanity, and the same aspirations toward real-
ised goodness that modern races are conscious of,
and that have been too often denied as character-
istics of the long unknown and countless masses
of humanity too commonly termed 'heathen."

Thousands of years before the Christian era the
regions of Central Asia were the abodes of ad-
vanced civilisations. India, the home of archi-
tectural beauty, the source of music and the
sciences, whose sacred Vedas are older than any
other writings on the surface of the earth, 1 who
invented the decimal system, and made vast dis-
coveries in geometry and trigonometry, and whose
astronomical observations dating from 3000 B.C,
are still extant, was peopled by a race 'well
versed in war and politics, bright, clever, merciful,

1 A Short History of Aryan Medical Science, by Bhagvat
Sinh Jee. London and New York, 1896, pp. 14-26.

India 29

righteous." Here the man was "devoted to the
protection of his family, ' and the woman " held
a high social position." Here the belief prevailed

'that creation had a maker who was eternal and
without cause, and that there was originally no
sin or disease. How easily might these words,

4 sin" and ;' disease,' be held to be synonymous !
The Vedas speak of God as the 'first Divine
Physician ' and thus address Him : ' I hear thou
art the best among physicians."

As man fell away from his primal purity and
disease shortened his life, Brahma, in pity for his
sufferings, gave him the Ayur-Veda, the books
that treat of the prevention and cure of disease,
and the twin brothers, children of the Sun — the
life- and health-giver — were the divine physicians
who first practised medicine and surgery. Such
is the legend in outline. The books of the Ayur-
Veda are not legendary but real, and are in eight
parts, treating of major and minor surgery and
bandaging, of diseases of all parts of the head
(nervous diseases), of medical diseases, demoniacal
possessions (insanities), children's diseases, poisons
and their antidotes, materia medica, and geni-
to-urinary diseases. Charaka and Susruta, real
personages about whom many myths have clus-
tered, were the most distinguished among physi-
cians and surgeons. Susruta is said to have lived
fourteen centuries B.C. 1 ; Charaka, probably about

^Medicine in Ancient India, by Surg. General C. A. Gordon,
M.D. London, 1887, p. 10.

30 A History of Nursing

320 B.C.1 The wisdom of the serpent-god with the
thousand heads, who was the depository of all the
sciences and especially of medicine, was supposed
to be incarnated in Charaka.

The association of the serpent with medical
science and healing is interesting. From the
earliest ages, and in all nations, the serpent was
venerated as the symbol of wisdom, as having the
power of discovering healing herbs, and, because
of the casting of its skin, it was also revered
as the emblem of immortality. 2 But Tylor in
his Primitive Culture says that this last idea is
of later origin than the time of the Hindoo
civilisation.3

The ancient Hindoos believed that the preven-
tion of disease was more important than the cure,
and their medical works contain innumerable
rules of hygiene. From immemorial times inocu-
lation was practised for small-pox, as in other
old nations. Massage was in constant use as a
health measure, and there were female practi-
tioners of massage for women. Every Hindoo was

> Jee op. cit., p. 33.

2 Ibid., p. 32.

3 " Of all forms of animal worship that of the serpent was
most widespread. It existed in every land, while other
animals only had local worship. The snake was the soul-
receptacle, in which dwells the soul of ancestors (as in India
and Rome), or it has the healing and mantic power of wisdom
(Babylon and Greece), or was an evil spirit, — a world-snake
or dragon. Perhaps most fundamental is the connection
between serpents and the treasures which they guard."
Internal. Encyc., art. " Nature Worship."

India 31

required to bathe at least once a day, and all the
daily duties were made into religious observances.
" After early rising, even before sunrise," says the
ordinance of Manu, 'let him void feces, with
covered head, bathe, decorate his body, clean his
teeth, apply collyrium to his eyes, and worship
the gods. ' The cleansing of teeth was done
twice a day with a stick cut from certain tonic
or astringent plants, ' with care not to hurt the
gums." The tongue was to be cleansed with a
curved, blunt scraper made of gold, silver, or
other metal, and many quaint instructions were
given: The wearing of clean apparel, perfumes,
and garlands is agreeable, productive of fame and
longevity, dispels distress and ill-luck, contributes
to cheerfulness, adds to beauty, makes one
worthy of going to respectable assemblies, and is
otherwise auspicious."1 The ethical teaching of
the Hindoos directed toward securing a favourable
prenatal influence is so pure and noble that few
modern nations stand, in this regard, on so high a
plane. 2 The lying-in room was to be clean, with
ventilators in the north or east wall, and the mid-
wives were to be trustworthy, skilled in their
work, and to have their nails cut short. Also the
knowledge of contagion is assumed in the maxim
* It is not safe to put on clothes, shoes, or garlands
worn by others."

There are more details of nursing to be found in

1 Charaka-Samhita, translated by Avinash Chandra Kavi-
ratna, Calcutta, no date, p. 60.

2 See Jee, op. cit., p. 78.

32 A History of Nursing

the Hindoo records than in other ancient chron-
icles. Lesson IX of Ckaraka-Samhita gives this
interesting exposition :

The Physician, the Drugs, the Nurse, and the
Patient constitute an aggregate of four. Of what
virtues each of these -should be possessed, so as to be-
come causes for the cure of disease, should be known.1

Physician.- -Thorough mastery of the scriptures,
large experience, cleverness, and purity (of body and
mind) are the principal qualities of the physician.

Drugs. — Abundance of virtue, adaptability to the
disease under treatment, the capacity of being used
in divers ways, and undeterioration are attributes
of drugs.

Nurse- -Knowledge of the manner in which drugs
should be prepared or compounded for administra-
tion, cleverness, devotedness to the patient waited
upon, and purity (both of mind and body) are the
four qualifications of the attending nurse.

Patient. — Memory, obedience to direction, fearless-
ness, and communicativeness (with respect to all that
is experienced internally and done by him during the
intervals between visits) are qualities of the patient.

As in the task of cooking, a vessel, fuel, and fire are
the means in the hands of the cook; as field, army,
and weapons are means in the victor's hands for
achieving victory in battles; even the patient, the
nurse, and drugs are the objects that are regarded as
the physician's means in the matter of achieving a cure.

Like clay, stick, wheel, threads, in the absence of

1 Translator's note: "In India the 'Nurses' mentioned are
always males or, in rare cases only, females."

India 33

the potter, failing to produce anything by their
combination, the three others, viz., drugs, nurse,
and patient, cannot work out a cure in the absence
of the physician.1

In the primal village communes of the ancient
Hindoos, among the administrative officials there
was always the physician or health officer, and
among the establishments pertaining to or main-
tained at the expense of these village communi-
ties were institutions of the nature of hospitals
for the reception and treatment of sick travellers
and the animals belonging to them. To each
hospital so established medical specialists were
appointed.2 These hospitals were, later on, ex-
tended and developed by King Asoka, in the third
century B.C. A description of 'a proper place in
which to care for the sick," as translated from
the old books, reads as follows :

In the first place a mansion must be constructed
under the supervision of an engineer well conversant
with the science of building mansions and houses.
It should be spacious and roomy. The element of
strength should not be wanting in it. Every part
of it should not be exposed to strong winds or breezes.
One portion at least should be open to the currents
of wind. It should be such that one may move or
walk through it with ease. It should not be exposed
to smoke, or the sun, or dust, or injurious sound
or touch or taste or form or scent. It should be

1 Charaka-Samhita, op. cit., pp. 102-103.

2 C. A. Gordon, op. cit., pp. 3-6.

VOL. I.— 3.

34 A History of Nursing

furnished with staircases, with pestles and mortars,
privies, accommodation for bedding, and cook-rooms.

After this should be secured a body of attendants1
of good behaviour, distinguished for purity or cleanli-
ness of habits, attached to the person for whose
service they are engaged, possessed of cleverness
and skill, endued with kindness, skilled in every kind
of service that a patient may require, endued with
general cleverness, competent to cook food and
curries, clever in bathing or washing a patient, well-
conversant in rubbing or pressing the limbs, or raising
the patient or assisting him in walking or moving
about, well-skilled in making or cleaning beds,
competent to pound drugs, or ready, patient, and
skilful in waiting upon one that is ailing, and never
unwilling to do any act that they may be commanded
(by the physician or the patient) to do. A number
of men should also be secured that are skilled in
vocal and instrumental music, in hymning encomiums
and eulogies, conversant with and skilled in reciting
verses and pleasant discourses and narratives and
stories and legendary histories, clever in reading the
face and understanding wrhat is wanted by the patient,
approved and liked by him upon whom they are
to wait, fully conversant with all the requirements of
time and place, and possessed of such politeness as
to become agreeable companions.

A cow should also be kept, yielding copious milk,
of a quiet disposition, healthy, having all her calves
living, well tended with food and drink, and kept in a
fold that is properly cleaned. So also should be

1 Baas, op. cit., p. 41, says that the Vaisyas, or lower caste
of two sub-castes of Brahmins, were the nurses.

India 35

kept little vessels or cups, larger vessels for washing
the hands and face. . . . cloths made of cotton and
wool, strings and cords, beds and seats, vessels
called Bhringaras full of water, and flatter vessels
for holding spittle and evacuations, all placed ready
for use; good beds placed upon bedsteads and over-
laid with white sheets, and containing pillows, for
use when sleep is needed, . . . plasters, fomentations,
. . . and diverse kinds of instruments, domestic and
surgical. Smoking tubes, . . . brushes and brooms,
balances and weights, measuring vessels and baskets,
. . . emetics and purgatives, and articles that are both
emetics and purgatives, those that are astringent, that
increase the appetite, promote digestion, cool the system
and destroy the wind, should be kept ready. Besides,
such other articles should be kept ready as may be
needed in view of other anticipated evils. Other
things, again, that may conduce to the ease, comfort,
and happiness of the patient, should similarly be
kept ready . . . . *

'In India, as elsewhere," says Jolly,2 ''the
physician is the descendant of the exerciser and
magician," He points out further the similarity
between the medicine of the ancient inhabitants
of India, the North American tribes, the ancient
Romans, Germans, and other primitive or bar-
barous folk. But the Hindoo physician had
arrived at a highly scientific state ages before the
Christian era, The permission of the king was
necessary for the practice of medicine, "for

1 Charaka-Samhita, op. cit., part vi.

2 Grundriss der Indo-Arischen Philologie, Band iii., Heft
10, Strassburg, 1901, art- "Medizin," by Julius Jolly, p. 16.

36 A History of Nursing

otherwise quacks will ply their trade throughout
the kingdom and become a nuisance." Their ideal
physician was not inferior to the ideal of to-day :

The physician shall keep his hair and nails short;
bathe daily and wear white garments, shoes, and
carry a cane or an umbrella. So attired, and ac-
companied by a faithful servitor he shall go forth
to his practice, his whole thought concentrated on
the healing of the patient, and do him good even at a
sacrifice to himself. No thought shall he have for
the wives or possessions of others, nor shall he speak
abroad of what goes on in the house. . . . The doctor
shall treat the patient as he would his own son. *

For an operation the room must be clean and well
lighted, with a fire burning, on which sweet -smelling
substances were to be burned in order to prevent
devils (another word for germs?) from entering the
patient through the wound.2 The surgeon must be a
rapid and strong operator, and he must neither per-
spire, shake, nor utter exclamations. The surgeon
must take blunt, pointed, and sharp instruments,
cautery and flame, cupping appliances and leeches,
measures, (for fluids), catheter, cotton, linen, thread,
dressings and bandages, honey and melted butter,
oil, milk and stimulants, salves, and materials for
poultices. There must also be fans, hot and cold
water, and receptacles. There must be strong and
capable assistants, and the patient must previously
have eaten but little. The operation must take place
under a favourable constellation, be preceded by a
religious ceremony and followed by a long prayer from

1 Jolly, op. cit., pp. 21-23.

2 Wise's Hindu Med., p. 184, quoted by Berdoe, p. 103.

India 37

the doctor. After the operation the patient is re-
freshed with cold water. The physician, after wash-
ing the wound with drugs, wipes it with linen, covers
it with cloths soaked in medicines, lays over that a
poultice, then a compress, and finally all is bound
with linen and bandaged. After three days a clean
dressing is put on.1

This would appear to have been the method
for a suppurating wound. When stitches were
taken the wound was closed well together,
covered with linen, and a healing powder was
thickly strewn on it. The Hindoos had fifteen
principal varieties of bandage, and they invented
many operations which are now considered
triumphs of modern science.2

Their writings deal with gynecology and obstet-
rics, the new-born, every kind of fever and medical
disorder, phthisis, insanity, leprosy, and specialties
of the nervous system and senses. Their books
mention one hundred and twenty-five surgical
instruments, for all manner of operations. They
were familiar with many kinds of enemata, and
the bulb they invented for this purpose remained
the pattern for enema bulbs up to the eighteenth
century. It was a leather bag or a bladder with
tube of silver, copper, ivory, or gold.3 Their
materia medica was large and they used drugs
which produced insensibility in place of ansesthe-

1 Jolly, op. cit., p. 30.

2 Berdoe, op. cit., p. 117.

3 Ausldndische Krankenpflege, by Dr. med. S. M. Brenning.
Zeitschrtft fur Krankenpflege, Berlin, 1905, part i., p. 57.

38 A History of Nursing

tics. In observations on the pulse they described
twenty varieties. The practice of inoculation
for small -pox in India was general, and this was
also true of China. The following extract from
the writings of Millingen relates the details of its
observance : 1

In Hindostan, if tradition may be relied upon, in-
oculation has been practised from remote antiquity.
The practice was in the hands of a particular tribe
of Brahmins, who were delegated from several re-
ligious colleges, and who travelled through the
provinces for this purpose. The natives were strictly
enjoined to abstain during a preparatory month
from milk and butter; and, when the Arabians and
Portuguese appeared in that country, they were
prohibited from taking animal food also. These
were commonly inoculated on the arm, but the girls,
not liking to have their arms disfigured, chose that,
it should be done low on the shoulder ; and whatever
part was fixed upon was well rubbed with a piece of
cloth, which afterwards became a perquisite of the
Brahmin. He then made a few slight scratches on
the skin with a sharp instrument, and took a bit of
cotton, which had been soaked the preceding year
in variolous matter, moistened it with a drop or two
of the holy water of the Ganges, and bound it upon
the punctures. During the whole of this ceremony,
the Brahmin always preserved a solemn countenance,
and recited the prayers appointed in the Attharna
Veda, to propitiate the goddess who superintended
the small-pox. The Brahmin then gave his instruc-

1 Curiosities of Medical Experience, J. G. Millingen, M.D.
London, 1839, p. 14.

India 39

tions, which were regularly observed. In six hours
the bandage was to be taken off, and the pledget al-
lowed to drop spontaneously. Early next morning,
cold water was to be poured upon the patient's head
and shoulders, and this was to be repeated until the
fever came on. The ablution was then to be omitted ;
but, as soon as the eruption appeared, it was to be
resumed, and persevered in every morning and
evening till the crusts should fall off. Confinement
to the house was absolutely forbidden ; the inoculated
were to be freely exposed to every air that blew, but
when the fever was upon them, they were sometimes
permitted to lie on a mat at the door. Their regimen
was to consist of the most refrigerating productions
of the climate; as plantains, water melons, thin
gruel made of rice or poppy seeds, cold water, and
rice. . . .

Inoculation appears to have been nearly as ancient
as the disease, if we can credit the missionaries
who were sent into China by the Church of Rome, and
who gained access to the historical records : they have
transmitted detailed accounts of the history of the
Chinese, and of their knowledge in various branches
of science. There is a memoir written on the small- pox
by the missionaries at Pekin, the substance of which
is extracted from Chinese medical books, and espe-
cially from a work published by the Imperial College
of Medicine, for the instruction of the physicians of
the empire.1

The predominance of Buddhism, which was a
religion of tenderness and compassion, was con-
temporary with the height of Hindoo civilisation.

1 Millingen, of>. cit., footnote, pp. 14-15.

40 A History of Nursing

The state of the people in the fourth century B.C.
is thus described by Gordon from old historians :

Theft was unknown : the people temperate : false-
hood held to be an iniquitous thing: the people
enjoyed to a great extent immunity from disease:
maturity was early and life prolonged. There was
no compulsory or unpaid labor: cultivators lived
on their land and paid a share of their produce to
the king; food was abundant; roads were good,
with sheltering avenues; . . inns and other estab-
lishments for strangers were everywhere, including
hospitals and dispensaries. At intervals there were
rich towns and cities, the houses large and beautiful,
the streets well watered, the gardens full of flowers
and fruit trees ; . . . the people prosperous and happy ;
none were poor or fed on unclean things.1

There may still be seen in India the edicts cut
in the rocks in the reign of King Asoka, who died
in 226 B.C., directing that hospitals shall be
erected along the routes of travellers ; that they be
'well provided with instruments and medicine,
consisting of mineral and vegetable drugs, with
roots and fruits " ; and also, ''Whenever there is no
provision of drugs, medical roots, and herbs, they
are to be supplied, and skilful physicians ap-
pointed at the expense of the State to administer
them." The public hospitals were schools of
medicine, and the older physicians took the stu-
dents into their homes. The best era of Hindoo
medicine was from 250 B.C. to 750 A.D. Public
hospitals were abolished when Buddhism fell,

1 C. A. Gordon, op. cit. p. 22.

India 41

750-1000 A.D. With the conquest by the Moham-
medans and the subsequent exploitation of the
country by foreigners the ancient glory of India
faded, and the lower ranks of the people are to-day
sunk into deplorable poverty, ignorance, and
superstition. Medical missionaries and nurses
who have penetrated into the life sufficiently to
see the sufferings of the sick, and especially of
women, relate experiences which make the ac-
counts of the ancient humane civilisation sound
like dreams, and which wring the hearts of all
lovers of mankind. The Brahmins believe it to
be contaminating to touch blood or morbid matter,
and under such doctrines medicine and nursing
are doomed to extinction.

CHAPTER IV

CEYLON

BESIDE the records of India stand those of
Ceylon, which possesses an equally touching
history of beneficent deeds and philanthropy.
There, too, an advanced and brilliant civilisation
once covered the land with magnificent cities,
roads, and temples, and learning was adorned by
charity. We are told that the architecture was
such that one city, with its gardens and lakes,
covered an area of twenty square miles, and was
built entirely of white marble. The sacred books
of Ceylon,1 which explain the origin, doctrines,
and introduction into the island of Ceylon of the
Buddhist religion, treat also of medicine. One
gives a description of the effects of different sorts
of medicines; another of the different sorts of
''choicest medicines." Another treats of foods
and their effects; another gives a collection of
figures to be worn as amulets when the disease
is supposed to have been caused by an evil spirit.
Another is called the " First book of the physicians,

Sacred Books of Ceylon, by Edw. Upham. Parbury &
Allen, London, 1833.

Ceylon 43

by which everything about physic may be known,''
The "merciful and beautiful ethics of the Buddhist
belief are strikingly shown in these old writings,
and explain perfectly the long list of good works
which are related in detail and which will be
quoted presently. "Sin entered the world by
avarice, covetousness, and anger.' 'The place
of happiness is to be secured by charity, with a
pure heart," and again and again we find records
of 'giving all one's treasures to the poor, " and of
being 'equally charitable to all men." But
the devils have the power of inflicting sickness, and
Guadama Buddha obtained the power of healing it,
Of these ancient volumes the second one brings
the history of the past down to 540 B.C., so that
the great antiquity claimed for the first volume,
the Mahawanse, must be conceded to it. 1 This
venerable record is full of references to hospital
and nursing work. The King Dootoogameny, be-
ing afflicted with a mortal disorder, commanded
the scribes to read to him the memorial of the
good works he had done, and among many bene-
factions to the temples and the priests there had
been also hospitals built at eighteen different
places, and physicians appointed on pay from the
King to attend to the sick, and medicines and food
supplied for them from the royal stores, according
to the prescriptions of the doctors. Many other
charitable deeds were done to the needy, and the
King, hearing of his benefactions, rejoiced greatly

1 Uphani, op. cit., vol. iii., p. 201.

44 History of Nursing

and said: " All these being done by me during my
reign, I am not satisfied with them; but the two
almsdeeds which I did while I was in want, and
which I performed without regarding my life, I
prefer to the whole, and I am satisfied with them.'
Another king caused great alms to be granted to
many priests, including medicinal supplies. " Bud-
daduwsa succeeded his father," continues the
chronicle. ' He was charitable and regarded every
one with affection like as a father regards his
children; he was in the habit of curing diseases."
'The King Udanam erected several temples and
halls for the sick, and he did many other charities. '
King Parackramabahoo "built many large
square halls in the midst of the city and kept alms
to be distributed yearly . . . and kept al-
monries at the four gates of the city, which were
furnished with several metal vessels, cots, pillows,
bedding, and cows yielding milk . . . and
great hospitals were built for the use of the sick
people, furnishing them with victuals, and [a
definite and interesting reference to nursing]
slave boys and maidens to wait upon and nourish
the sick."1 He provided also "stores containing
abundance of medicaments and other necessary
things, and employed learned physicians to attend
the patients both day and night, and the King him-
self in person used to visit them, . . . and
being attended by the ministers of the state and
other officers he came and advised the physicians,

1 Upham, op. cit., vol. i., pp. 195-272.

Ceylon 45

as he himself was properly qualified in the art of
physiology, and inquired after the health of the
sick, and supplied those who were cured with
clothing."1 These records contain several al-
lusions to priestesses, who are mentioned as bein^
"thousands" in number, but there is nothing to
show whether their duties included the care of
the sick. Nevertheless the supposition that, like
their successors in later European convents,
they may have directed and supervised the
nursing of the great hospitals, at least in the
women's divisions, cannot seem quite visionary.

The ancient Persians were also required by
their laws to provide suitable houses for the sick
poor in their communities, and the king was
expected to furnish the best medical treatment
for the inmates free of cost. An epic of early
times reveals much about the care of the sick
that could otherwise not be discovered of Persian
medicine.2 The epic dates from 224-642 B.C.,
but was not compiled until later. It mentions
three kinds of physicians, those who heal by the
knife, those who heal by plants, and those who
'heal by exorcism and incantations; and there are
descriptions of various surgical and medical pro-
cedures, some of wrhich belong in the province of
nursing, though there is no mention of nurses as
such. Dr. Wylie tells us that the modern Parsees

7 Upham, op. cit., vol. i., pp. 195-272.

2 Zur Krankenpftege im alten Persien, Dr. Paul Horn
Zeitschrift fur Krankenpftege, Berlin, May, 1903, pp. 169-173.

46 History of Nursing

or fire worshippers still continue to build hospitals
in the cities, several important ones having been
erected in the nineteenth century.1

i W. Gill Wylie, M.D., Hospitals, Their History, Organiza-
tion, and Constriction, (D. Appleton& Co., New York, 1877),
p. ii.

CHAPTER V

EGYPT

HPHE oldest medical records which the modern
1 world possesses are those of Egypt, of whose
wonderful old civilisation so much of absorbing
interest is being revealed to-day through the
labours of archaeologists. Like India, ancient
Egypt had an extensive knowledge of astronomy,
the arts, sciences, and medicine. She named the
planets, whose number has become the symbol
of mystic power, — the sacred number Seven, -
and arranged the calendar in the form in which
Caesar carried it to the West. 1 Thoth, the scribe
of the gods and type of divine intelligence, who
invented writing and letters, who measured time
and was the god of right and truth, cut upon
stone pillars the first medical precepts, and these
were afterwards transcribed on papyrus and col-
lected into a number of sacred books. Thoth had
many points of resemblance with the Greek
Hermes, and the mystic writings are called the

1 History of All Nations, edited by John Henry Wright,
LL.D., Philadelphia, and New York, 1902, vol. i., by Ferd-
inand Justi, p. 115,

48 History of Nursing

Hermetic books (inspired or compiled by Thoth,
Hermes). Isis (Mother Earth) and Osiris (The
Day or Light, who "suffered a cruel death at the
hands of his brother Set the god of Darkness"),1
the best known of the Egyptian deities, were re-
garded as having invented agriculture and the
medical arts. Horus, the sun, who typified the
conquest of light over darkness, or good over
evil, was the son of Isis and Osiris, and learned
medicine from his mother, as well as the gift of
prophecy. The sacred books were forty- two
in number, of which six dealt with medical sub-
jects. Amelia B. Edwards, the Egyptologist, says:
" Works on medicine abounded in Egypt from the
remotest times, and the great medical library of
Memphis, which was of immemorial antiquity,
was yet in existence in the second century of our
era, when Galen visited the valley of the Nile.
The Egyptians seem, indeed, to have especially
prided themselves on their skill as physicians, and
the art of healing was held in such high esteem
that even kings made it their study. Ateta,
third king of the first dynasty, is the reputed
author of a treatise on anatomy. He also covered
himself with glory by the invention of an infallible
hair- wash, which, like a dutiful son, he is said to
have prepared especially for the use of his
mother."2 The famous papyrus now in the mu-

1 Revised version of the Bible, Append., p. 19.

2 Pharaohs, Fellahs, and Explorers, by Amelia B. Edwards,
p. 218. Harper & Bros., New York, 1892.

Egypt 49

seum at Leipsic, and believed to be one of the
Hermetic books, is described as follows by Miss
Edwards :

No less than five medical papyri have come down
to our time, the finest being the celebrated Ebers
papyrus, bought at Thebes by Dr. Ebers in 1874.
The papyrus contains one hundred and ten pages,
each page consisting of about twenty-two lines of
bold hieratic writing. It may be described as an
Encyclopedia of Medicine as known and practised
by the Egyptians of the eighteenth dynasty, and it
contains prescriptions for all kinds of diseases-
some borrowed from Syrian medical lore, and some
of such great antiquity that they are ascribed to
the mythologic ages, when the gods yet reigned per-
sonally upon earth. Among others we are given the
receipt for an application whereby Osiris cured Ra
of the headache.1

Von Klein says : " The exact date of the writing
of this papyrus has not yet been established.
The calendar which is on the outside of the
papyrus refers to the eighteenth dynasty, in the
sixteenth century B.C.' The contents of the
papyrus vary in age, from between 1552 to 4688
B.C. Many of the diseases known to modern
science are carefully classified and their symptoms
minutely described. Over seven hundred sub-
stances from the mineral, vegetable, and animal
kingdoms are given as drugs, covering every known

1 Pharaohs, Fellahs, and Explorers, by Amelia B. Edwards,
p. 219. Harper & Bros,, New York, 1892.

50 History of Nursing

physiological action, . :nd are made up into decoc-
tions, infusions, injections, pills, tablets, troches,
capsules, powders, potions, and inhalations, and
into lotions, ointments, plasters, etc.1 These com-
pounded prescriptions, as also the allusions in
the books of Moses to apothecaries, give evi-
dence that a distinct class of apothecaries existed
among the ancient Egyptians. The Hebrews,
during their stay in Egypt, learned Egyptian
medicine, and the Old Testament is full of medical
allusions.2

An interesting relic of Egyptian medicine is the
medicine chest of the wife of Pharaoh, Mentuhotep,
2500 B.C. It contains six vases of alabaster and
serpentine, dried remnants of drugs, two spoons,
a piece of linen cloth, and some roots, enclosed in
a basket of straw-work. It was found in the
Queen's tomb.3

Houdart 4 and other writers account in the
following way for the origin of the medical books
of ancient Egypt. It is supposed that there, as
in other ancient countries, it was the custom in
remote times to lay the sick in the street in order
that they might' benefit by the advice of the

1 The Medical Features of the Papyrus Ebers, Carl H. von
Klein, A.M., M.D., Bulletin Amer. Acad. of Medicine, Feb.,
1906, pp. 314 et seq.

2 Klein quotes from Exodus xxx., 25-35; xxxvii., 29,:
Eccles. x., i; II Chron., xvi., 14.

3 Ibid., p. 320.

4 Histoire de la Medicine Grecque depuis Esculape fusqu'a
Hippocrate, M. S. Houdart, Paris, 1856, pp. 71, 73.

-j"wn--.-, •— -icw

A Domestic Medicine Chest of an Egyptian

Queen, Aientuhoiep, in the Berlin Museum.

It contains five alabaster flasks and one of ser-

pen'ine containing medicines. Near it lie

two spoons, a small dish, and a number

of medicinal roots
By courtesy of Dr. von Kle'n

Egypt 5 i

passers-by. Those who by experience had learned
some useful remedy stopped and gave the patients
advice and recipes for treatment. In Babylon
there was even a law compelling them to do this.
(It has been observed that such a law would be
unnecessary to-day.) These recipes, with an
account of the symptoms, were collected and kept
by the priests in the temples, where for many
ages every one was free to go to consult them and
to select his own treatment. In this way a vast
number of facts were collected, which little by
little acquired a sacred character and were re-
garded as infallible. Berdoe says1 : The art of
medicine in ancient Egypt consisted of two
branches, the higher, which was the theurgic
part, and the lower, which was the art of the
physician proper. The theurgic class devoted
themselves to magic,2 counteracting charms by
prayers, and to the interpretation of the dreams
of the sick who had sought aid in the temples.
The inferior class were practitioners who simply
used natural means in their profession.' As
these old records show, they brought medi-
cine to a high plane of learning and culture.

1 Op. cit., p. 61.

2 It is possible that the word "magic" does not to-day
convey an impression in accordance with the actual state of
ancient medicine. The Egyptians practised hypnotism and
knew how to control the mind and imagination. Houdart
quotes Bacon assaying that "the honourable significance
once given to the word ' magic ' as ' research ' or ' knowledge '
should be given to it again.'

52 History of Nursing

They were called Pastophori, but Ebers says that
the Pastophori had many duties, and were not
all physicians, though all physicians might be
said to be Pastophori, as it was essential that they
should belong to the priestly class. It is not
clear who actually gave the orders for the practical
treatment of the patient, — the priest magician
or the priest physician, — or who actually carried
them out.

To deviate from the recipes of the sacred books
was regarded as so dangerous that the physician
who did so, and whose patient died, was himself
punished with death. If, however, the patient
died under treatment given according to the
sacred books, the physician was not held re-
sponsible. This rigid conservatism at which
Egyptian medicine ultimately arrived, by pre-
venting the progress of further knowledge, and by
forbidding experiment, stifled thought and ambi-
tion, and eventually brought about its downfall.

Beside the actual treatment of disease the
ancient Egyptians had established public hygiene
and sanitation upon a remarkably thorough scale.
Their civil laws contained so much about the care
of the health that those who knew and obeyed
all were called doctors.1 They appear to have
had a corps of sanitary inspectors or health
officers, for Houdart quotes an old writer who said
that " it has been proved that in time of pestilence
the police were as useful as physicians, ' and his

1 Houdart, op. cit., p. 81.

Egypt 53

opinion was that one reason for limiting the
province of the doctors in the matter of treatment
was that if they were allowed to experiment with
new remedies they might nullify or interfere with
the work of the sanitary officers.1 The ancient
Egyptians, at least those of the higher classes,
were exceedingly cleanly, bathing several times
a day, keeping their faces shaved, and they also,
for reasons of cleanliness and hygiene, practised
circumcision. They were well acquainted with
the uses and varieties of enemata, ointments,
liniments, and massage. They used opium, cas-
tor oil, and many other drugs used to-day; prac-
tised surgery, did excellent dental work, and
bandaged beautifully. Their belief in immor-
tality led them to embalm their dead, and this
practice shows their great knowledge of preserv-
ative drugs and a certain amount of anatomy.
On the other hand this very sacredness of the
human frame made a thorough study of anatomy,
such as must underlie a progressive science,
impossible.

There is no mention to be found of nurses, yet
it seems unreasonable to suppose that a nation
which had brought medicine, pharmacy, and
sanitation to so orderly and systematic a state
should not have had a nursing class; or that
women should not have taken an active share in
good works, more especially when we consider
what is known of the general humanitarianism

i Houdart, op. cit., p. 75.

54 History of Nursing

of the Egyptians and the favourable position of
their women. Budge 1 says that the social
position of women was always much higher in
Egypt than in other Eastern countries; 'the
mother or ' lady of the house ' enjoyed a po-
sition of authority and importance rarely met
with among other nations.' Of their humanity
Brugsch 2 writes : ' Laws which ordered them to
pray to the gods, honour the dead, give bread
to the hungry, water to the thirsty, clothing
to the naked, reveal to us one of the finest quali-
ties of the old Egyptian, --pity towards the
unfortunate. *

Nor have modern researches yet disclosed any-
thing definite of hospitals in ancient Egypt,
although it is conjectured that the temples of
Saturn may have been resorted to by the sick.
That there were priestesses or 'temple women'
is certain ; what their duties were is not so clear.
Caton3 says: There is reason to believe that
institutions closely related to infirmaries or hospi-
tals existed in Egypt many centuries earlier than
the Hieron of Epidauros, but no structural trace
of such building has been discovered.' If there
were indeed hospitals there must also have been
nurses, and we may feel reasonably sure that their

1 A History of Egypt, by E. A. Wallis Budge, M.A., Litt.D.,
D.Lit. Kegan Paul, Oxford, 1902, vol. ii., p. 20.

2 Egypt under the Pharaohs, by Heinrich Brugsch Bey,
London, and New York, 1891. p. 10.

3The Temple and Ritual of Asklepios, by Richard Caton,
M.D.. F.R.C.P., C. J. Clay & Sons, London, 1900.

Egypt 55

duties were well defined and circumscribed. As
to what must have happened to them if they
disobeyed the physician, we can form an estimate
by what happened to him if he disobeyed the
sacred books.

CHAPTER VI

BABYLON AND ASSYRIA

NEXT in antiquity to the medical records of
ancient Egypt are those of Babylon, which
came to light when the French expedition dis-
covered at Susa in Persia the celebrated Code of
Hammurabi. 1

Hammurabi — a historical, not a mythical per-
sonage— wras the greatest of Babylonian kings
and statesmen. He reigned about 2250 years
B.C. during a glorious period of some sixty years.
The celebrated ;'Code' is a legal one. The laws
contained in it — many, it is supposed, having been
compiled from other and far older sources — were
collected and unified by Hammurabi. It contains
some curious provisions for regulating the art of
surgery, and also that of the veterinarian, thus
showing that these two specialties were distinct
and held the same relation to each other and to
medicine that they do to-day. It fixed a table of
fees for operations, varying from two shekels for

'The material in this chapter is taken mainly from "Cunei-
form Medicine," by Prof. Christopher Johnston, read at the
meeting of the American Oriental Society, April 16, 1903.

An Egyptian Prince and his Nurse

Babylon and Assyria 57

an operation on a slave to ten shekels for one on
a freeman, and severe penalties for the surgeon
who was so unsuccessful as to have his patient
die on the table. If this happened to a freeman
the surgeon's hands were cut off; if to a slave, the
operator had to pay the owner the price of his
servant. Although the records are scanty, there
is enough to show that medicine was practised
from the very earliest times and was regarded as
of the utmost importance. The Babylonians are
not believed to have had any exact knowledge of
human anatomy, but to have learned what they
knew of the internal organs from the sacrifices of
animals. They had a good empiric knowledge
of drugs and treatment, but the priests kept it
jealously guarded from the common people. They
understood blood-letting, and letters extant from
a court physician dating from 680 B.C., speak of
tamponing the nose for epistaxis and of an excel-
lent application to the face in erysipelas.

The Babylonian deities were nature gods. The
three greatest were the gods of the sky, the earth,
and the sea. Next in rank were the moon god,
the sun god, the god of thunder, lightning,
wind, rain, and storm: of the planet Venus;
Marduk or Merodak (light), (who is also called
Bel), the quickener of the dead, who fought and
vanquished the dragon or ;< Chaos' (darkness);
Nebo, the god of arts, science, and letters, and
others.1 Besides these they had innumerable

i 'Revised Version of the Bible, Oxford, 1904. Appendix, p. 29.

History of Nursing

local deities, and held the primitive theory that
disease was caused by the wrath of gods and by
evil spirits. This early idea they developed and
elaborated extensively, creating entire hierarchies
of good and evil spirits which were ever in conflict
with one another. Safety lay only in invoking
the aid of the good against the bad angels.1 So
long ago was symbolised the struggle between
good and evil, which still perplexes many minds-
the world-old contrast of health and disease,
whether physical, mental, or moral.

The ancient Assyrians went even further in
speculation and evolved the theory that sickness
was a punishment for sin and could only be cured
by repentance. It may be that this idea was
based on a genuine insight into Nature's laws of
health, and that it really marks the dawn of ra-
tional physiological teaching. Much depends
upon the interpretation of the words ;' sin ' and
' repentance, ' ' and this may have been a poetic
way of saying that those who broke physiological
laws would get sick and could only be cured by re-
turning to an observance of hygienic rules. How-
ever, according to Baas,2 the Assyrians, so far as is
known, practised only magic and empiric medicine
and were not scientific. Many old ideas of the

1 Prof. Paul Haupt says: "The Babylonian Winged Genii
were the prototypes of the angels to whose forms we are
accustomed. The Babylonian Cherubs originally symbolised
the winds carrying the pollen from the male flowers to the
female." (i2th Internat. Cong, of Orientalists, 1901.)

2 Op. cit., p. 22.

Babylon and Assyria 59

Babylonians, which doubtless originally had some
naturalistic basis, are still extant to-day as popu-
lar superstitions. They believed much in the
potency of lucky and unlucky numbers, all number
myths having been derived from observations of
the stars and heavenly bodies, the changes of the
moon, the number of the planets, etc. The
sacredness of the number seven was shown in
old Assyrian law that no work should be done
on the seventh day. This was the old law
quoted to Jesus by his disciples. There also
existed many regulations about the gathering
of the medicinal herbs and simples: — some must
be gathered by night, others at dawn, or at a
certain time of the moon. These doctrines must
all have arisen from some practical knowledge of
plants. No gardener to-day would cut flowers for
the table in the hot midday sun, but only early in
the morning, before they are wilted, and so these
old rules were surely founded on some natural
fact now overlooked or forgotten.1 Charms and
amulets were used extensively. The magic num-
ber seven appeared in knots tied in cords, of which
there are still survivals. Symbolism was prac-
tised extensively in their medicine. The purify-
ing bath and sprinkling with holy water — such
natural and beautiful evidences of the value
attached by all people, and especially in hot
countries, to life-giving springs of water — were

1 Many country people still regulate all garden work by
the "up" or "down" of the moon, but do not know why.

60 History of Nursing

symbols of the deepest import which all nations
shared with them. Then, too, the cleansing bath
was certainly a most practical form of symbolism.
Disease was also symbolically cured by fire,
small objects being burned in a brazier, while
the priest recited the appropriate incantation.
Fire, the most perfect purifier from a sanitary
standpoint, is also a practical sanitary aid,
besides being symbolic. In rightly estimating
all these practices of the ancients it is important
never to forget the highly poetical imagination
and the tendency to figurative and symbolic
language of all primitive and all Oriental peoples.
Many of the Babylonian incantations are highly
poetical, and no doubt tended to soothe and con-
sole the sufferer in away that more literal- minded
Western folk cannot understand.

CHAPTER VII

THE JEWS

OF all the nations of antiquity the Jewish race
has the most wonderful history of sanitary
excellence and high attainments in hygiene. l
Theirs was truly a religion of health and phys-
ical and mental sanity. As a noble simplicity
characterised the spiritual and moral side of the
Jewish religion, so a rational intelligence directed
all the practical affairs of life from the stand-
point of enlightened hygienic knowledge. The
innumerable deities of other nations, and more
especially the evil genii of the Babylonians and
Assyrians, were abhorred of the Jewish leaders,
who continually denounced superstitious practices
and inculcated a belief in one God. The ancient
Hebrews appear to have had in a highly cultivated
state the faculty of critical comparison and judg-
ment which enabled them to choose from contem-
porary nations the best and reject the worst.
Thus the Jews learned much of their hygiene from

'With the exceptions noted the material for this chapter
has been taken from The Sanitary Laws of Moses, by G. M.
Price, M. D., Public Health Record, May, 1901.

62 History of Nursing

the Egyptians, but rejected their theurgy. The •
Egyptian priests and physicians do not appear to
have made their vast knowledge a part of the
heritage of the commonest and lowest of the
people. They had an aristocracy of knowledge,
whereas the special feature of the Jewish culture
has always been the democracy of knowledge.
Certain sanitary measures practised by the Egyp-
tians only among the educated or priestly classes,
as, for example, circumcision, were enforced by
the Jews from the highest to the lowest.

The laws ascribed to Moses cover every detail
of personal, family, and public or national hygiene
and are directed toward the maintenance of health
and prolongation of life. "Therefore shall ye
keep these commandments that ye may be strong
and prolong your days, ' says the prophet.
Virchow has called Moses " the greatest physician
of all time. ' The laws of individual hygiene
concern themselves with questions of labour, of
rest, personal cleanliness (for which there are
innumerable rules), and diet, and severe are the
" medical punishments" threatened for the wrong-
doer. " The Lord shall smite thee with consump-
tion, and with fever, and with inflammation, and
with an extreme burning. ' All the stern and
ungraciously sounding texts relating to the ' un-
cleanliness' of women, which when considered
only in the abstract seem so needlessly humiliating, ,
are in reality witnesses of the extreme care and
solicitude of the Jews for the health of their

The Jews 63

women, and of the sanctity and beauty of their
family life. These regulations secured to women
the personal isolation and privacy, quiet, and
consideration necessary on hygienic grounds, and
especially made the time of childbirth a period of
isolation and quiet, of cleanliness of body and
clothing, and of rest for mind and body. All of
the principles of modern sanitation were antici-
pated by the Jewish lawgivers. The inspection
of food; the preservation of useful trees; the
methods for the disposal of excreta; the impor-
tance of vital statistics ; the diagnosis and notifica-
tion to the authorities of infectious diseases; the
necessity of isolation or quarantine, and of
fumigation and disinfection after contagion, all
are found in the Old Testament, The Mosaic and
Talmudic regulations for the examination and
slaughtering of animals and the inspection of their
internal organs for the detection of diseases before
they were permitted to be used for food are in line
with the most advanced sanitary ordinances
to-day, and modern medicine has only lately re-
discovered the dangers of the oyster as a carrier
of pathogenic bacteria, while to the Jews the eating
of shell-fish has always been forbidden on sanitary
grounds. There were four cardinal points to be
observed about animal food. First, blood was
always and absolutely forbidden as an article of
food. For this reason meats are always drained
of their blood before cooking, and no orthodox
Jew will buy a killed chicken, but only live ones,

64 History of Nursing

to be killed and bled scientifically. Next (a law
accepted by people in general), animals torn by
wild beasts or otherwise accidentally killed, or
those having died of themselves, were not to be
used as food ; and finally, the pig was forbidden as
unclean. All Oriental nations have shared this
aversion to the pig. The Hindoos regard it as
unclean, and the ancient Egyptians held the same
opinion, no doubt because, in hot countries, the
pig is especially liable to disease.

From the standpoint of humanity and the care
of the afflicted the Jews have an unbroken and
glorious record. An ancient ordinance, which
was also the old Athenian code of humanity and
which strikingly resembles the Egyptian ordinance,
defines neighbourliness as follows : ' Not to refuse
fire to any one who asks for it; not to cut off a
stream of water; to offer food to beggars aiul
cripples; to give decent burial to unclaimed dead;
not to add additional suffering to one who is in
trouble; not to treat animals with cruelty. ' "To
visit the sick in order to show them sympathy,
to cheer and aid and relieve them in their suf-
fering, is declared by the Rabbis to be a duty
incumbent upon every Jew even if the sick person
be a Gentile. There is no specific command to
this effect in the Old Testament, but the Rabbis
find allusions to it in several passages of the Pen-
tateuch. The 'haberim' or 'Hasidic' associa-
tion made the performance of this duty a special
obligation, and visiting the sick is enumerated in

The Jews 65

Matthew xxv., v. 36, among the various forms
of charity. In the Shulhan Aruk Yoreh. De'ah
a whole chapter is devoted to the commandments
concerning such visits. " 1 These familiar " Hasid '
works of charity were regarded as having been
practised from the beginning of the world. There
existed of old, and still exist, Bikkur Hohin
societies whose particular object it is to visit and
care for the sick. The ancient Hasidim were
divided into groups, one for each of the seven
branches of charitable work mentioned in rabbini-
cal literature, of which one is to visit the sick.
The ancient Jews also had the ocenodochium or
' pandok ' for travellers and destitute persons,
to which was attached the ptochotropheum or
Sick House.2 This institution, as St. Jerome said,
was transplanted from East to West "as a twig
from Abraham's terebinth.' It was the custom
of the Jews to give one tenth of their possessions
in charity, and against the tendency of the
Essenes and Christians to give all they had the
rabbis ordained that no one should give away
more than one fifth, in order that they should
always be able to support themselves and their
families. Among the Essenes, whose pure ethics

1 See Jewish Encyclopedia, arts., " Sick," " Charity."

2 The Houses for the Sick in the early Jewish period were
called "Beth Holem." The " Beth Said" mentioned in the
New Testament was such an institution. They were probably
humble enough ancestors of the superb modern hospital, for
they are supposed to have been wooden huts or cabins.
(Internal. Encyc. art., " Hospitals.")

VOL. I. 5.

66 History of Nursing

led them to renounce animal food, to refuse to
hold slaves, and to dignify manual labour, the care
of the sick was a constant duty. Thus Philo1
says of them : ' Nor do they neglect the sick who
are unable to contribute their share, as they have
in their treasury ample means to offer relief to
those in need. ' And again, " If any one be sick,
he is cured by medicine from the common stock,
receiving the care of all. '

1 Quoted in Jewish Encyc. art., "Essenes."

CHAPTER VIII

GREECE

IN a part of the Greek peninsula endowed by
nature with special and enchanting beauties
of restful plain and encircling pine-covered hills,
lie the marble ruins and excavated foundations
of Epidauros, the most famous of ancient health
resorts, where the temple of Asklepios once stood
in its glory, surrounded by dazzling white marble
buildings: hostels, hospital wards, bath-houses,
gymnasia, residences for attendants and priests,
out-door theatres, libraries, and temples for
sacrificial rites — the whole set in green gardens
and spaces of idyllic beauty. Ancient Greece had
many temples of Asklepios, but this was the most
sumptuous and the most famous. Many, although
not all, had provision for entertaining patients, and
in their arrangements they were much like
sanatoria to-day, although it is not certain that
the poor were treated in them.

Like Egypt and yet older countries Greece
traces her medical art back to a mythical past of
divine origin. Apollo, the sun-god, was the god

68 History of Nursing

of health and of medicine. Asklepios, the marvel-
lous physician, was his son, and became in turn
deified and worshipped. One may easily believe
that there was, in dim ages past,1 some mortal of
more than ordinary skill and wisdom, the fame
of whose ability to heal became glorified with
time to a supernatural degree, and that the
achievements of this mortal man are perpetuated
in the myth of Asklepios. The two sons of
Asklepios, Machaon and Podaleirios, were truly
mortals, for they both accompanied the Greek
army to the Trojan war in the capacity of surgeons.
May not the little clamps and dressing forceps
now in the museum of Constantinople, discovered
by Schliemann in the ruins of Troy, have belonged
to their outfit? Homer mentions their father,
Asklepios, in the Iliad, speaking of him as the
" blameless physician. '

The dream-oracle, as all the authorities agree,
was the universal characteristic of the Asklepios
cult. In the dreams of the sick there came to them
the stately figure of the god, with his benignant and
fatherly countenance, and told them what to do
to be well. In the earliest times of the cult there
were no physicians,2 but as the fame of the cures
grew the priests acquired more and more practical
knowledge, and specialised into two main divisions,

1 A date about thirteen centuries B.C. is assigned to
Asklepios. Baas, op. cit., p. 55.

2 The Cult of Askle-pios, by Alice Walton, Ph.D., Cornell,
1894, p. 67.

Hygeia and Asklepios
Tn the Vatican

Greece 69

one retaining the purely priestly, the other the
medical functions. Finally with time a school
of physicians was developed, who were called the
Asklepiades, and under their direction centres of
medical teaching were founded, most often, al-
though not always, in connection with the
temples; and medical treatment became syste-
matic and extensive, including major and minor
surgery, hydrotherapy, massage, frictions, gym-
nastic treatment, baths, and hypnotism.

Inseparably connected with the cures of Askle-
pios was the worship of the serpent, and even to-
day the image of the snake remains the emblem of
the wisdom of the physician. Alice Walton dis-
cusses interestingly1 the myths connecting the
serpent with power against sickness, as illustrated
in the story of Moses and the serpent of brass in
the wilderness.

The essential idea WTas that the spirits of the
dead, who often appeared in dreams, inhabited
the underworld. Thus the Earth, the abode of
the Dead, was the Mother of Dreams. The
serpent also lives in the underworld, and was
identified with or related to the ideas concerning
the soul. According to different phases of primi-
tive thought, the serpent was regarded as a symbol
of the soul, or as the soul itself, or as a dwelling
of the soul.2

1 Op. cit., pp. 11-16.

2 On animal worship, See Lang's Customs and Myths, chap.,
' Fetichism and the Infinite."

;o History of Nursing

No one knows how far back in the past Greece
possessed anything like a hospital, but it is said
that temples of Asklepios existed in 1134 B.C. at
Titanus in the Peloponnesus. It is well known
that hospitality was a sacred obligation of the
ancients, and was practised by them toward the
stranger, the sick, and the needy, with an abun-
dance which doubtless rendered unnecessary much
of the institutionalised charity of to-day. The
" xenodochion " was a feature of Athens and other
cities of Greece and gave its name as well as its
leading outlines to the later institutions of the
Christian Fathers. It was a municipal inn or
hostel for strangers of every kind and degree,
especially the sick and the poor. There was
also the private surgery, or iatrion of the Greek
physicians, a sort of dispensary where advice was
given, operations were performed, and drugs
compounded. Here private physicians sometimes
received patients for treatment, but these small
institutions often had a bad reputation. Every
large city had its public iatrion as well, which in
some cases was supported by a special tax, but
there is no evidence that patients could remain in
them for nursing or treatment.1 They are spoken
of by Galen as large and airy buildings.2 A
frightful inconsistency marred, however, the hos-
pitality of the ancient Greeks. Only curable

1 Withington, op. cit., p. 78.

2 Geschichte Christlicher Krankenpftege und Pflegerschaften,
Dr. Heinrich Haescr, Berlin, 1857, p. 96. Anmerkungen.

Greece 71

patients were received, and the incurables were
left to die upon the streets. It was considered
that birth and death polluted a locality, and these
two events were not allowed to happen in the
sacred precincts of the temples of Asklepios. At
Epidauros, women approaching confinement and
patients about to die were carried outside the
gates and left there. One can only hope that
individual kindness could and did find some way
of aiding them. Definite provision was not made
for these two helpless classes until the time of the
Antonines, 138 A. D., when a home for the dying and
a maternity hospital w^ere founded outside of the
precinct.

A fascinating account of the ancient cure at
Epidauros is given by Caton in his Temple and
Ritual of Asklepios.1 The abaton, a long Ionic
portico in two parts, one for men and one for
women, with a double colonnade and open to the
south like a long piazza, was the sleeping place
or ward for the sick after their arrival, where they
expected to have the miraculous dreams. : The
ruins now marking the site of this building are
highly interesting, for they constitute the earliest
known example of a hospital ward. It was
furnished with pallets, lamps, tables, altars, and
probably curtains, the patients supplying their
own bed-clothing "2; (this is still the custom in
Eastern hospitals). The abaton had a capacity

1 Op. cit., p. 9.

72 History of Nursing

of about 120 beds, and Dr. Caton suggests that the
large square buildings having many small single
rooms (just the right size for a patient) , of which
the foundations can be plainly seen, were intended
for transferred patients or for convalescents. The
remains of these buildings show enough rooms to
accommodate 400 to 500 patients. At the great
religious festivals thousands assembled, but the
greater part of these could not have been sick
persons, and may have been put up in tents, or
temporary structures, or in the neighbouring
villages.

The list of officials given by Caton shows many
resemblances to that of modern hospitals. The
chief official (superintendent?) was the Hiereus or
Hierophant. He was sometimes but not always
a physician. He was the general administra-
tor and shared in the financial government of
the temple. There were the Dadouchoi,- -torch
bearers, who were probably subordinate priests;
the fire-carriers,- -Pyrophoroi ; key-bearers, Klei-
douchoi, who later had priestly functions; secular
officers, --Hieromnemones, who attended to re-
ceipts and payments (clerks and bookkeepers).
The Nakoroi or Zakoroi were a rather indefinite
class, of uncertain duties, who were sometimes
physicians. Finally, there were priestesses, — the
Kanephoroi, or basket bearers, and the Arrephoroi,
or carriers of mysteries and holy things. All
were under the rule of the Boule of Epidauros
(hospital Board of Directors?). With reference

Restoration of the Interior of the Abaton at Epulauros. Patient sacrificing
and having injured leg licked by the sacred serpent

From The Temple and Ritual of Askh-pios. By permission of Richard Caton, M.D.

Greece 73

to the priestesses, Caton says: " Did these women
in any degree act as nurses? It is possible, but
no definite information is given.' The inscrip-
tions speak of bath attendants and of servants
who ministered to the sick and carried those
unable to walk.

He also gives a pretty picture of the ward
procedures. The patient upon arrival probably
had an interview with the priest or official, and
arranged about his accommodation. He performs
certain rites, bathes in the sacred fountain, and
offers sacrifices under the direction of the priest.
The poor ones give only their cake, the rich ones
a sehep, pig, or goat, or other offering in addition.
One little boy gives his jackstones. * At night the
patient brings his bed-clothing into the abaton
and goes to rest, after putting some small gift on
the table or altar. (The cleansing bath, says Alice
Walton, was all-important, and white gowns were
the rule both for patients and priest, as there was
an ancient belief that white garments induced
favourable dreams. Some one else also might
dream for the sick person, — perhaps a friend, or
the priest himself.) The Nakoroi come to light
the sacred lamps. The priest enters and recites
the evening prayers to the god, entreating help
for all the sick assembled there. He then collects
the gifts ; the Nakoroi come back and put out the
lights and enjoin silence, commanding every one
to fall asleep and hope for a guiding vision of

'Walton, op. cit.

74 History of Nursing

the god. According to the inscriptions the god
appeared in person or in visions, and spoke to the
patients about their ailments. Whether these
visions were hallucinations, the work of the
imagination, or of some priest in the dim light,
or dreams caused by opium or other dream-
producing drug, or some acoustic trick, it cannot
be said.1

The region of Epidauros was in olden times the
habitat of a species of a harmless yellow snake,
now extinct, which men revered as being the
incarnation of the god himself. These reptiles
were quite tame, and were accustomed to be
handled and fed with cakes by the sick, who
regarded it as a propitious sign when one of the
snakes approached them.2 The serpents were
trained to lick the affected parts with their
tongues, and dogs, likewise sacred to Asklepios,
were also trained to lick the patients' wounded or
injured members.

The history of Epidauros and other temples of
Asklepios, is related in the numerous inscriptions
and tablets which have been found and translated.
The earliest ones give absurd tales of miraculous
cures, but later on the tablets show less supersti-
tion and more science. Thus Apelles, who suf-
fered from severe indigestion, was put on a diet
of bread and curdled milk, parsley, and lettuce,

1 Caton: op. cit. pp. 28, 29

2 There was also a traffic in snakes, and the}'' were sold to
other countries in time of pestilence.

Greece 75

and lemons boiled in water, and was told to
avoid fits of violent anger.

As scientific knowledge and rational treatment
advanced the Asklepiades maintained, as early
as 770 B.C., a number of medical schools, and
temples of Asklepios with sanctuaries for the sick
were very numerous. Three of the most famous
medical schools were those at Cnidus, Rhodes, and
Cos, and it was at Cos that the great Hippocrates,
the Father of Medicine, was born, 460 years before
Christ.1 He belonged to the family or order of
the Asklepiades, and was believed to have been a
direct descendant in the sixteenth generation of
the great Asklepios himself.

The golden age of Greece, the age of Pericles, was
the auspicious time of the appearance of one of
the greatest physicians who ever lived, and whose
attainments in medicine rank nobly with the
achievements of that period in art, poetry, and
citizenship. Hippocrates openly recognised Na-
ture and taught that disease was not the work of
spirits, demons, or deities, but resulted from
disobedience to natural laws. He called Nature
the ' just, ' and showed that the true art of the
physician was to assist her in bringing about a
cure. Possessed of a master mind and unequalled
powers of observation and reflection, he was
equally modest, had no mysteries, and taught

1 See Hippocrates and the Newly Discovered Health Temple
at Cos. Richard Caton, M.D., William Clowes and Sons,
London, 1906.

;6 History of Nursing

openly all that had previously been jealously
guarded, acknowledging medical errors as directly
as he taught the truth, ' . . . discarding both
superstition and hypothesis and substituting
the results of actual observation in the place of
both. ' He was possessed of vast and exact
knowledge in the whole realm of medicine, and
was the author of many treatises both medical and
surgical which are still regarded as classics. His
primary conception of the mission of medicine is
that of nourishing the patient :

For the Art of Medicine \vould not have been in-
vented at first ... if when men are indisposed the
same food and other regimen which they eat and drink
when in good health were proper for them, and if no
others were preferable to these.1

His famous description of the countenance
before death is too well known to need repeating,
but perhaps few nurses know with what perfection
and minuteness he has described all that they are
taught of symptoms and the meaning of every
shade of expression, change of position, points to
observe about the senses, the breathing, the sleep,
and every phase of illness, or how careful and
modern are his directions for hot applications,
dry and moist, and for all manner of appliances.
About bathing he says :

1 The Genuine Works of Hippocrates, trans, by Francis
Adams. William Wood Co., New York, 2 vols. in one (no
date), p. 133-

Greece 77

If the patient is not bathed properly he may be
hurt thereby in no inconsiderable degree. . . . The
person who takes the bath . . . should do nothing for
himself, but others should pour the water upon him
and rub him, and plenty of water of various temper-
atures should be in readiness for the douche, and the
affusions quickly made; and sponges should be used
. and the body anointed when not quite dry.
But the head should be rubbed until it is quite dry ;—
the extremities protected from cold as also the head
and the rest of the body.1

About bandaging he says:

There are two views of bandaging, that which
regards it while doing and that which regards it when
done. It should be done quickly ... by dis-
patching the work; without pain, by being -readily
done ; with ease, by being prepared for everything ;
and with elegance, so that it may be agreeable to
the sight. . . . When done it should fit well and
neatly. The bandage should be clean, light, soft, and
thin."2

One of the most perfect examples of his teachings
is to be found in the following recommendation-
which unfortunately is often disregarded:

The prime object of the physician in the wrhole art
of medicine should be to cure that which is diseased :
and if this can be accomplished in various ways the
least troublesome should be selected.3

Even an outline of this great medical teacher's

1 The Genuine Works of Hippocrates, vol. ii., p. 252.

2 Ibid. vol. ii, p. 10.

3 Ibid. vol. ii., p. 151.

78 History of Nursing

life and work is impossible in the present book,
the scope of which only allows the mention of a
few details of his teaching on lines which are
most nearly related to practical nursing. He laid
down the rule that fluid diet only should be given
in fevers, and also advised cold sponging for high
temperatures. He allowed his fever patients to
drink freely of barley water and cold acidulated
drinks. For acute tonsilitis he ordered hot
fomentations and hot gargles, cathartics and cool
drinks. For colic he gave warm enemata and
warm baths, hot fomentations, purgatives, and
anodynes. His sympathetic nature is shown in
his instructions never to expose the patient un-
necessarily during examinations or operations.
It is much to be regretted that no direct reference
to nurses and their work is made in the writings
of this master of the medical art. He said, it is
true, that the assistant was the co-worker with
the physician, but no treatise on nursing as such
has come from him. Yet that he must have taught
all its principles is evident in his own writings
and those of later physicians, who, 2000 years
ago and more, were evidently well acquainted
with every detail of gooft nursing. A German
writer has recently compiled all the teachings of
the Greek physicians on nursing. l Thus Aretasus,

1 Dr. Med. M. Brenning of Berlin. His Ausldndiscl-te
Krankenpflege, in the Zeitschrift fur Krankenpftege, Berlin,
1905, in two parts, pp. 53-57, 102- 107, from which we borrow
our text , goes into these details.

Greece 79

a physician of Cappadocia who flourished about
100 A.D., speaks of the necessity for strict cleanli-
ness. The bed-clothes must always be clean, as
soiled ones cause pruritus. Powders are to be
used for a moist skin, and the mouth wash must
be used constantly, both for cleansing and to
refresh patients who are not allowed much to
drink.

Aretaeus gave much thought to the bed:
'The kind of bed and its position are very im-
portant. It must be steady, not too large or
wide, and for patients with hemorrhage of the
lungs it must not be too soft or warm, while for
tetanus and kidney trouble it must be soft, warm,
and very smooth. The sick who dare not speak
much must lie high. The covers must be light
and made of old soft stuff. Excitable patients
must have covers without patterns, as they are
annoyed by the spots and designs. The light is
to be managed according to the illness; lethargic
patients are to have a bright light. ' Celsus (born
50 B.C.) also speaks much of proper clothing.
Fever patients are to be lightly covered ; also those
with heart disease or respiratory difficulty. Pa-
tients suffering from renal affections should be
warmly dressed. All the old writers had much to
say about the sick-room. For fevers the room
must be large and airy, with plenty of fresh air.
Cardiac diseases and dyspnoea must be treated in
a cool room with the windows open. Excitable
patients must be in a rather small room, cool and

8o History of Nursing

moist in summer and warm in winter. The walls
should be smooth and of a monotone in colour. No
paintings or pictures should be allowed, because
in delirium the patients get excited, jump out of
bed, and grasp at them. The subject of food
receives much attention. Celsus is especially
thorough on this topic. Fever cases must at first
have nothing solid, and must drink so as not to be
thirsty, yet not too much. He gives exact rules
for children and old people, and for the number of
days after fever when solid food may be recom-
mended. The times for eating are also important.
During and after meals perfect quiet must prevail,
and the patient must hear no disquieting news. If
it is necessary that he be told something unpleas-
ant, he must hear it after a nap following food.
Fever patients must have only one kind of food
at a time, as this is more easily digested than
several kinds. Cardiac patients must have only
very small quantities of the lightest nourishment,
at regular times, both day and night. The con-
sumptive must drink much milk. The dyspeptic
must avoid wine and seasoned foods. In kidney
disorders the patient must drink much, but take
no cold or seasoned food or drink. Many physi-
cians limited nephritic patients to a milk diet.
Aretaeus gives many directions for feeding the
insane and apoplectic. For the latter he advised
that a long spoon should be placed over the
epiglottis. Insane patients who refused food were
often placed between two convalescents who were

Greece 81

eating, and thus an inclination to eat was aroused.
Beside giving directions as to the kind and
quantity of the food, its temperature, and the
number of times it was to be given in a day, he
advises that attention should be paid to the
personal preferences of the patient. Rufus 1 holds
that the physician should always consider the
patients' taste with care, because unaccustomed
foods do harm, more than those to which the
patient is used, and those prepared in a way
which the patient likes will be better digested than
if he dislikes them.

For the relief of pain warm baths, fomentations,
hot-water bladders, poultices, light massage, and
many plasters and salves were in use. To soothe
the nervous the bed was hung as a cradle and
rocked, or brought near to a fountain. Sweet
essences were rubbed on the patient's face or his
feet, his head was stroked, or he was scratched
gently on the temple and around the ears. Music
was also used to soothe and lull. Music and gentle
rocking both had a high place for nervous and
irritable cases, Melancholies were to hear music
and cheerful, amusing tales. Insane patients
were to be kept occupied, their work made pro-
minent and often praised. After purging they
were to have light diet, and they were often
massaged. Change of scene and travel was recom-
mended for them, and their friends were never to
speak of anything disturbing. For epileptics also

1 A. D, 98-117.
VOL. I. — 6.

82 History of Nursing

long walks through wooded paths were recom-
mended, and for cardiac patients it was advised
that they should look out on green fields or be
cheered by flowers, paintings, and the sight of
water. This teaching shows that, outside of the
giving of drugs, the nursing and care of the pa-
tient were understood by the ancient Greeks in
a way that can hardly be improved upon to-day. l
According to Withington, in the heroic age of
Greece women carried on quite a little medical
practice among their own sex, and Baas says:

'Women in Greece, as in all countries, doubtless
did much noble if unnoticed work as nurses."2
The Iliad contains occasional allusions that shed
light on the medical knowledge of women, as, for
instance, the lines on Agamede the fair-haired

'who knew all drugs so many as the wide earth
nourisheth." In the classic days of Greece, the
sphere of women was closely restricted to the
household, where nursing the sick slaves was one
of the duties of the mistress of the mansion.

1 All from Brenning, op. cit.
7 Op. cit., p. 80.

CHAPTER IX

ROME

A NCIENT Rome is but young and modern in
i\ comparison with classic Greece and venerable
Egypt and India. Her earliest known history
was only beginning at the time when the Askle-
piades had already founded medical schools and
when health resorts had been established all over
Greece. Nor did the Romans evolve a religion, a
medical system, or an art of their own, but bor-
rowed largely from other nations, and most abun-
dantly from Greece. Greek physicians introduced
the medical sciences into Rome, built temples, and
were for a long time the only practitioners there.
Although it is conjectured that the Etruscans in
a remote past had medical knowledge and hospi-
tals, too little that is definite is known of this
mysterious race, and the earliest recorded knowl-
edge of the uses of herbs and the making of potions
was brought to Rome by the men of the Abruzzi
and the shores of Lake Fucino,1 who no doubt
had learned the homely arts of their grandmothers.

1 Ancient Rome in ihe Light of Recent Excavations.
Rodolfo Lanciani, Houghton, Mifflin, Boston, 1889, Chap.
" Sanitary Conditions of Ancient Rome," pp., 49-73.

84 History of Nursing

Malaria, says Lanciani, became prevalent with
the subsidence of volcanic activity in the old
Latium, and the Romans built shrines to the god-
dess of fever and the evil eye; to Cloacina (the
goddess of typhoid?) and to Verumnus, the god
of microbes. According to the precepts of Numa,
the peace and good-will of the gods were the only
remedies and means by which lost health could be
regained. In times of pestilence, temples were
built to Apollo, one of which stood on a site near
the theatre Marcellus, and another near the Bar-
berini palace. The introduction of medical
knowledge to the Romans by the Greeks was made
some time in the third century B. c., when a
terrible pestilence was devastating the city. In
despair, the Romans consulted the Sibylline books,
the only source of wisdom known to them, and
the oracle replied that Asklepios must be brought
from Greece to Rome. The story goes that a
galley was straightway sent, and that one of the
sacred serpents was brought back. As the galley
came up the Tiber, the serpent sprang out on the
little island in the river, in the heart of the city.
It was regarded as a divinely chosen spot, and a
temple was erected there to Asklepios, or, as the
Romans called him, ^Esculapius. As the Greek
physicians were at this period teaching the en-
lightened medical precepts of Hippocrates and his
successors, we must hope that a medical staff
accompanied the serpent; and it would seem
probable that such was the case and that this

Rome 85

became a teaching centre, for Lanciani says:
The island became the greatest sanitary institu-
tion of the metropolis, and has ever since beer
devoted to hospital uses. The present hospital
of San Giovanni di Calabita stands near the site
of the old /Esculapian temple."

Perhaps the graciousness of the Greek spirit
softened a little the stern and practical character
of the old Romans. At any rate the picture given
of the influence of the new cult by Walter Pater
in Marius the Epicurean is a charming one. Ma-
rius, when a young lad, was taken to a temple of

among the hills of Etruria, as was then usual in such
cases, for the cure of some boyish sickness. The relig-
ion of /Esculapius, though borrowed from Greece, had
been naturalised in Rome in the old republican times ;
but had reached under the Antonines the height of its
popularity throughout the Roman world. . . . Sains,
salvation, for the Romans, had come to mean bodily
sanity. The religion of the god of bodily health,
Salvator, as they called him absolutely, had a chance
just then of becoming the one religion ; that mild and
philanthropic son of Apollo surviving, or absorbing,
all other pagan godheads. The apparatus of the
medical art, the salutary mineral or herb, diet or
abstinence, and all the varieties of the bath, came to
have a kind of sacramental character, so deep was the
feeling, in more serious minds, of a moral or spiritual
profit in physical health, beyond the obvious bodily
advantages one had of it; the body becoming truly,
in that case, but a quiet handmaid of the soul. The

86 History of Nursin

priesthood or "family" of /Esculapius, a vast college,
believed to be in the possession of certain precious
medical secrets, came nearest, perhaps, of all the insti-'
tutions of the pagan world to the Christian priest-
hood; the temples of the god, rich in some instances
with the accumulated thank-offerings of centuries
of a tasteful devotion, being really also a kind of hos-
pitals for the sick, administered in a full conviction
of the religiousness, the refined and sacred happiness,
of a life spent in the relieving of pain.

When Mafius goes to walk in the temple garden,
summoned by one of the " white- robed brethren,"
his guide points out to him in the distance the
1 Houses of Birth and Death, erected for the
reception respectively of women about to become
mothers, and of persons about to die; neither of
these incidents being allowed to defile, as was
thought, the actual precincts of the shrine." 1
Later, when he visited the temple itself,

his heart bounded as the refined and dainty magnifi-
cence of the place came upon him suddenly, in the
flood of early sunshine, with the ceremonial lights
burning here and there, and withal a singular expres-
sion of sacred order, a surprising cleanliness and sim-
plicity. Certain priests, men whose countenances bore
a deep impression of cultivated mind, each with his
little group of assistants, were gliding round silently
as they came and went on their sacred
business. ... In the central space . . . stood
the image of /Esculapius himself . . . not of an

lMarius the Epicurean, by Walter Pater, pp. 24, 25.

Rome 8;

aged and crafty physician, but of a youth, earnest
and strong of aspect, carrying an ampulla or bottle
in one hand, and in the other a traveller's staff, a
pilgrim among his pilgrim worshippers; and one of
the ministers explained to Marius this pilgrim guise :
One chief source of the master's knowledge of healing
had been observation of the remedies resorted to by
animals labouring under disease or pain, — what leaf
or berry the lizard or dormouse lay upon its wounded
fellow ; to which purpose for long years he had led the
life of a wanderer in wild places.1

Of enormous importance, as Lanciani points
out, in the prevention of fevers and the 'general
influence on the public health, were the colossal
engineering feats carried out by the Romans, viz.,
drains, aqueducts, good roads, drainage and
cultivation of the Campagna; and, not least of all,
proper cemeteries, for the old ones had been incon-
ceivably dreadful. Lastly, there was developed a
system of organised medical help. Julius Caesar
was the first statesman to dignify the study" of
hygiene by recognising its teachers as professors
of the liberal arts, with rights of citizen-
ship. Nero organised a medical service for Rome
and named a superintendent of court physicians.
Schools of medicine were opened and the students
formed themselves into corporations.2 A practical
knowledge of medicine and surgery was cultivated

i Marius the Epicurean, by Walter Pater, Macmillan Co.,
New York and London, 1896, pp. 27, 28.
2 Lanciani, op. cit., pp. 64-72.

88 History of Nursing

among the slaves of rich patrician families, many
of whom became very skilful and were often set
free in gratitude and recognition of their services.
It is mentioned that Augustine was cured by his
freedman with fomentations and cold compresses.
Massage and baths reached perfection among the
Romans, as they had done among the Greeks in
connection with athletic training, and the care of
the body in sickness became as highly developed as
in Greece. Rubbing and washing, warm and cold
baths, both for cleanliness and for therapeutic uses,
steam, oil, hot sand, steambox baths, and sitz-
baths were all in use,1 and there was ,a class of
professional masseurs, the iatraleptce. 2 The best
care and nursing in the knowledge of the Ro-
mans was given to the soldiers. Haeser tells us
that in the time of Fabius wounded soldiers
were carried to private houses. They were later
cared for, when sick, in tents or separate buildings
and nursed " by women and old men of irreproach-
able character."3 Later there were military hos-
pitals called I'aletudinar-ia, and a class of orderlies
as nurses, the nosocomi. Private persons also
supported similar institutions for their slaves,
where the masters often treated them themselves.
Very interesting remains of such a (military?)
hospital have lately come to light in excavations
near Baden, in Switzerland. It was divided into

Pfenning, op. cit., p. 102.

2 Considerations sur les Infirmieres des Hopitaux, by Anna
Emilie Hamilton, M.D. Montpellier, 1900.

Rome 89

fourteen rooms, and the number and kinds of ap-
pliances discovered show that the technique of
nursing must have been far more advanced than
had hitherto been supposed.1 There were found
measuring utensils and medicines and ointment
jars, injection points, bulbs, tubing, etc.2

An equally interesting discovery was made in
Pompeii and described in 1880 by Dr. Dake,3 who
thus relates his visit :

While looking through the great museum in the
city of Naples my attention was arrested by a col-
lection of surgical instruments comprising scalpels,
scrapers, elevators, forceps, drills, and a well-made
vaginal speculum, with a card attached saying they
were all taken from the ruins of Pompeii. After-
wards, while searching through the uncovered build-
ings in the streets of the old city, I asked the guide
if he could show me the place whence the instruments
had come. He promptly replied that they all came
from one building. We had traversed many well-
worn streets and seen many objects of interest when
our guide, taking us through a good-sized doorway
into a large room, said, 'I will now show you the
place where the instruments were found. ' The large
room extended from the street back the full depth
of the building, and on the right-hand side, about
midway from front to rear, was a hall running off at
right angles with a number of small rooms on either

1 Beitrdge zur Geschickte des Krankencomforts, by Dr. Paul
Jacobsohn, Deutsche Krankenpftege Zeitung, 1898, p. 141.

2 Brenning, op. cit.

3 Remains of a Hospital in Pompeii, I. P. Dake, M.D.,
T lie Medical Counsellor . May, 1880.

90 History of Nursing

side. In the first room on the left of the hallway the
instruments were found all in one spot. Surveying
the premises it was quite evident to me that we were
in a veritable hospital, but there was no sign to tell
whether it had been a public or a private hospital -
whether erected by many- handed charity or a private
taberna.

The tabernae or surgeries introduced by the
Greeks resembled dispensaries rather than hos-
pitals, but this instance suggests the extreme
probability of an extension to accommodate at
least temporarily patients who had been operated
on.

Lanciani attributes to the influence of Christian-
ity the organisation under Antoninus Pius of the
first service of public assistance, by which com-
pulsory and gratuitous medical service was pro-
vided for the poor. It was directed in each town
by medical chiefs, who were elected by the town
councils and approved by the heads of families.
But free or general hospitals, even in a rudiment-
ary form, were not known in Rome much before
the third century of the Christian era. *

The ancient Romans were not tender-hearted
like the Buddhists, or sunny and gracious like the
Greeks, or conscientiously charitable like the Jews.
A military civilisation is never distinguished by
the cult of humanity, and military, imperialistic
Rome was deficient in pity, or at least lacking in

1 Lanciani, op. cit., p. 68.

Rome 91

the imagination which stirs pity. But Lecky re-
minds us how unjust it is to judge of pagan, as
compared with Christian societies, by a mere com-
parison of their charitable institutions, and es-
pecially as the tendency of many writers has been
to record only the most hideous facts of pagan
society and to ignore all its milder features.1 He
points out the fact that both ancient Greece and
Rome were free from the superstition of demon-
iacal possession which has involved the sick and
insane in so much misery at other periods of the
world's history. 'A demon, in the philosophy of
Plato, though inferior to a deity, was not an evil
spirit," and it was 'extremely doubtful whether
the existence of evil demons was known to either
the Greeks or Romans until about the time of
Christ."2 The belief in evil spirits, in fact, came
from Assyria and Babylonia. Lecky mentions,
further, the state relief of the poor in ancient
Greece and Rome, always regarded as an import-
ant duty of the state, and many Roman charities,
namely, the support of poor children and needy
young girls, and the distribution of medicine to the
sick poor. He cites Epaminondas, who ransomed
captives and gave dowers to penniless maidens,
and Cimon, who fed the hungry and clothed the
naked, and recalls the inadequate notion of mod-
ern charity and benevolence that would be im-
parted by modern memoirs and poems. The most

1 Lecky, op. cit., vol. i., p. 73.

2 Ibid., vol. i., p. 380.

92 History of Nursing

enlightened principles of genuine relief-giving
based upon justice are expressed by Cicero, who
wrote : ' We must take care that our bounty is a
real blessing to those we relieve; that it does not
exceed our own means ; that it is not derived from
the spoliation of others; that it springs from the
heart and not from ostentation; that the claims
of gratitude and justice are preferred to mere
compassion, and that due regard is given both to
the character and the wants of the recipient."1
Nevertheless the record of ancient Rome, based
upon slavery and militarism, falls far short of
other pre-Christian nations in medicine, in nurs-
ing, and the humanities in general.

i Lecky, vol. i., p. 79.

PART II

FROM THE FIRST TO THE CLOSE
OF THE EIGHTEENTH CENTURY

CHAPTER I

WOMEN WORKERS OF THE EARLY CHURCH

BETWEEN the nurses of the pre-Christian civ-
ilisation and our own the historical links are
broken, but there is a continuity of record from the
days of the early Christian workers throughout
nearly two thousand years to the present day. The
marvellous activity of the early Church in works of
love and mercy swept into its current thousands
of men and women who, responding with eagerness
to the summons of one of the greatest of teachers,
lived thereafter only to show forth again in their
lives the love which had changed the face of the
earth for them. In this movement the large share
taken by women was as conspicuous as it was
significant. Yet it is a mistake to assume, as
many evangelical writers do, that the status of
women was strikingly or for all time elevated by
Christianity. Many such historians, in pane-
gyrising the benefits conferred upon women by
Christianity, have greatly overstated their case,
wholly ignoring, under paganism, all but the
worst and most degraded conditions, and con-

96 History of Nursing

trasting these solely with the just and lofty teach-
ings of Christ. As a matter of fact, the position
of women, socially and legally, was not always low.
under the old religions, nor has it been by any
means always high under the new. It has had
its cycles, like other social phenomena. While in
Eastern nations it is at present servile, such has
evidently not always been the case in, at least,
Egypt and India; nor can we recall the many
noble female figures of the Old and New Testa-
ments without realising the respect in which the
Jews held their women. Then, among ancient
Northern and Western nations the position of
women, as is well known, wTas notably favourable.

They were indeed regarded with veneration, and
shared in the councils and deliberations of the
men. ' In the songs of the Eddas the goddesses
are represented not only as sitting in halls on an
equality with the gods, but also as meeting in
council together and giving their opinions, which
were listened to with respect. The Gauls and
Germans regarded women as possessing some-
thing divine in their characters and as communi-
cating with the gods more easily than the men." l

Indeed the advice of women was honoured be-
cause it was believed that something prophetic
and divine dwelt in them. These "very Germans
who shattered the Roman Empire, and scarcely
knew what obedience was, willingly bowed their

1 Womankind of All Ages in Western Europe, by Thomas
Wright. London, 1869, pp. 27-37.

Women Workers of the Early Church 97

haughty necks before their women. The woman
was to the ancient German something sacred ; hers
was the privileged sex which stood in closer rela-
tion to the divinities."1

These Northern women whose position was so
high were also the physicians and surgeons, as
well as the nurses, of their race. Fort says that at
a remote period the feminine Druids and wives
of Northern princes had a just renown for medical
skill.2

In the mystic cult of Norse deities, priestesses
were reputed to possess such medical knowledge
as enabled them to cure diseases regarded as
incurable elsewhere. Pilgrimages were made to
the tombs of Scandinavian women who had been
famed in medicine, as they were later made to the
tombs of medical and nursing saints. Among the
ancient Germans the 'women were famous for
medical skill and were experts in obstetrics and
veterinary medicine. The account given by Taci-
tus of the part taken by the wives of Germans in
dressing the wounds of warriors is referred to in
every medical history. The view of some modern
medical historians, that the practice of medicine
was left to the women because it was thought

1 Die Weibliche Diakonie, in ihrem ganzen Umfang
dargestellt. In 3 vols.; Th. Schafer, Stuttgart, 1887. vol.
i, p. 271. Quoted from older sources, as also: "The old
German term for woman, now obsolete, survives only in an
obscure form in the English word 'queen.'

2 History of Medical Economy during the Middle Ages,
by Geo. F, Fort, M. D., Quaritch, London, 1883, Chap. iv.

98 History of Nursing

degrading to men, does not seem very plausible in
view of the great importance attached to health.

Undoubtedly in classic Greece women were
secluded and treated as children. This does not
appear to have been the case in Homeric times,
and in Rome the women of the old patrician
families enjoyed an exalted social position. Al-
though the strict legal code of Rome assigned to a
married woman the position of an absolute chattel
of her husband, yet it is only fair to remember
that similar laws still disgrace modern statute
books, and, from the time of the Punic wars, with
the gradual falling into abeyance of the old pater-
nal power, and the extended use of the free mar-
riage contract which left the matron her own
name, her legal independence and the control of
her own property, the Roman lady actually occu-
pied a position of freedom and great dignity.
"The Roman matron from earliest times had
secured to her by family religion a dignified
and respectable position. ... In the early years
of the empire her status both in law and in fact
really rose. She became more and more the equal
and companion of her husband and her influence
in public affairs more decided."1

Under the old marriage law the supreme power
of the father over the child had passed from the
parent to the husband. But during the empire
the Roman law recognised two classes of marriage :

1 Roman Society in the Last Century of the Western Empire,
by Samuel Dill, London, 1898, Book II., pp. 137-138.

Women Workers of the Early Church 99

the strict one, considered under the republic as
the most honourable, which made the wife the
property of her husband, and the personal con-
tract or free marriage, which was a co-equal
partnership and left her in a position of social
importance and legal independence in the control
of her own property.1

Lecky says : ' In the whole feudal legislation
women were placed in a much lower legal position
than in the Pagan Empire. Wherever canon law
has been the basis of legislation laws of suc-
cession have sacrificed the interests of wives and
daughters."2

It is not, therefore, possible to make the general
claim that Christianity greatly elevated the posi-
tion of women ; but the essential and inestimable
service that it conferred upon them was in enlarg-
ing vastly their opportunities for useful social
service, notably by opening the way to honourable
and active careers for the unmarried. Hitherto
the general view had been held that, with the
exception of certain recognised limited castes,
such as the priestesses or temple women, or the
Vestal Virgins, there was no place or dignity for
women outside of marriage. With the dawn of
our era, this conception was destroyed and the
right of the single woman to a position of useful-
ness and responsibility was established, with
results that can hardly be overestimated. It was

1 Lecky, op. cit., vol. ii, pp. 304-306.

2 Ibid., vol. ii., 339.

ioo History of Nursing

a part of the teaching of brotherhood which cut
at the roots of slavery by acknowledging the sov-
ereign individual in each human being. Under
this new and gracious ideal arose a fresh activ-
ity and aspiration for humanity, in which women
took a prominent part.

The earliest orders of women workers in the
Church, and the ones especially concerned with
nursing, were those of the Deaconesses and
Widows. Later appeared the Virgin, the Presby-
teress, the Canoness, and the Nun.1

Of these the first two and last only, played a part
in nursing. The others had ecclesiastical duties.
The canoness served in choir, at funerals, and
other ceremonies, and was not bound by vows to
community life. The chronicles of Christian
nursing begin with the diaconate,2 which included
men and women having similar functions, the
chief of which was the care of the poor and the
sick. From the earliest apostolic times deacon-
esses were placed on a level with deacons, and
the title "diakonus, ' as used by St. Paul in
speaking of Phebe of Cenchrea, was applied
equally to men and women. This is emphasised
by many writers, and at least two have suggested

1 For explanation and interesting details of each see Hand-
book to Christian and Ecclesiastical Rome, by M. A. R. Tuker
and Hope Malleson. Macmillan & Co., London and New
York, 1900. In three vols.

2 The probable origin of the word "diaconate" is related in
Acts, chap. vi. The verb diakonein, to serve, had had
especial reference to "serving tables" or distributing alms,

Women Workers of the Early Church 101

that the translation of the word 'diakonus' in
the New Testament as ' servant, " when applied
to Phebe, while not so translated in any other
connection, attests probably a reluctance on the
part of the translators to admit the equality of
women and men in the early church.1 Nor did
the women monopolise the nursing. On the
.contrary, as in ancient times, a large share of
these duties was assumed by man, whether as
physician, neighbour, or priest, so in the early
Christian period, and for centuries thereafter,
men of the priestly caste, or belonging to military
or religious orders, have been responsible for at
least one half of the nursing service through
mediaeval times up to a very recent period.

Phebe (A. D. 60), the friend of St. Paul who
enjoys the distinction of having been the first
deaconess, is believed to have had social standing
and wealth. Her journey to Rome, with the
statement of St. Paul " she hath been a succourer
of many and of myself also,': with other histor-
ical data, point to her as having been a woman
of importance and dignity.

The deaconess, ranking with the clergy, was

but, according to some writers, the noun was used by Christ
and the apostles in the sense of a "minister." Deacons, says
Haeser (op. cit., p. 9), were a Christian transformation of the
temple servants of the Jews and pagans.

1 See Deaconesses in Europe, by Jane M. Bancroft, Ph.D.,
New York, Hunt & Eaton, 1890, p. 14; also Deaconesses
Ancient and Modern, by the Rev. Henry Wheeler, Ne.v
York, Hunt & Eaton, 1889, pp., 45-46.

102 History of Nursing

ordained by the bishop, with the consent of the
congregation, by the laying on of hands. Her
duties, like those of the deacon, were both secular
and clerical. She was the first parish worker,
friendly visitor, and district nurse, and from her
day the work of visiting nursing has never been
unknown. Although all converts to the primi-
tive Church, more especially women with leisure,
regarded it as a sacred duty to comfort the
afflicted, it was the special duty of the deaconess
to attend the sick in their own homes. She also
visited prisoners, assisted the needy from the
church funds, counselled the afflicted, and carried
the messages of the clergy. Her religious duties
were very important, and of greater extent than
those of her sister the modern Protestant deacon-
ess. She taught, catechised, and brought the
women converts to baptism or baptised them
herself; stood at the women's door in the
churches and showed them their places; brought
them to the Lord's Supper and assisted at the
altar during the sacrament. Tuker and Malleson,
who give more explicit details than many writers,
say: The terms used for the ordering of men
and women clergy were always identical. Both
were ordained by the imposition of hands. The
new deaconess then sang the Gospel. The bishop
placed the stole on her neck, after which she
took the veil or pallium from the altar and
clothed herself with it. She also received a man-
iple, ring, and crown. . . . She administered

Women Workers of the Early Church 103

the sacraments to the confessors in prison, and
in the mass communicated the women with the
Cup, the deacons communicating the men. In
some places she read the homily, and deaconesses
are mentioned in several ancient lectionaries."1
The order of deaconesses spread far and wide,
over the provinces of Asia Minor, into Syria,
Rome, and throughout Italy, into Spain, Gaul,
and Ireland. It was especially active in the
Eastern church, where Oriental ideas made
women missionaries so necessary; less so in
Rome, where the orders of widow and virgin
became more prominent; most of all dignified,
perhaps, in Gaul and the ancient Irish church,
where, the position of wromen in general being
high, the deaconess played up to a late period
a role far more important than was known out-
side of small congregations in the Eastern or
Western church, and served at the altar in all
functions. Beside the deaconess, subdeaconesses
are mentioned in records dating from the third
century. They were not ordained by the imposi-
tion of hands, and did not count as a sacred order,
but were elected with the consent of the clergy 'by
the bishop. 2 There were also archdeacon esses.
St. Gregory of Nyssa speaks of his sister Macrina
as an archdeaconess. The primitive deaconess
might be married, or a widow, or virgin. It was
not until the second century that the sentiment in

1 Tuker and Malleson, part iv., pp. 526-527.
3 Ibid., part iv., pp. 532-524.

A History of Nursing

favor of celibacy became pronounced, and after
that date the deaconess was required to be 'a
pure virgin, or at least a widow who has been but
once married." She might also, as was equally the
case with the other orders of women workers,
live in her own home, nor is it clear that she at
first wore a special dress. The fourth council of
Carthage mentioned a special dress for deacon-
esses who have 'put away their lay garments,"
and a fresco from the catacomb Hermetis, repre-
senting two widows and deaconesses at the bed-
side of a sick person, showrs them in an ample
tunic with a stiff head-dress going round the face.
The deaconess' liturgical dress was the diaconal
alb, maniple, and stole.1

The deaconess likewise, at first retained control
over her property, and a state law then forbade
her to enrich churches and institutions at the
expense of those having just claims on her. 2

The letters of Chrysostom, who from 398 to
407 was bishop of Constantinople, give much of
interest regarding the notable women there who
were connected with the church: Amprucla,
whose 'manliness' -manly virtues, freedom of
speech, and boldness — he admired; Pentadia, the
widow of a Roman consul; Procla, Sabiniana,
Olympia; Praxides and Pudentiana, the daugh-
ters of a Roman senator; Nicarete, a noble virgin
whom he in vain urged to become a deaconess, but

1 Tuker and Malleson, part iv., pp. 526-527.

2 Bancroft, op. cit., quoting from old writings.

Women Workers of the Early Church 105

who devoted herself voluntarily to visiting nurs-
ing ; and Macrina, who was ordained as a young girl.
The most famous of these was Olympia who, in
addition to a noble and lofty character, much
sweetness, and the power of organising and leading
others, had the worldly advantages of great
wealth and commanding social position. She was
the wife of the prefect of Constantinople, was a
widow at eighteen and an ordained deaconess at
twenty years. The story is that after the death of
her husband the emperor Theodosius wished to
marry her to one of his kinsmen, and on her
refusal threatened her with confiscation of her
fortune (which was probably what he really
wanted). Being moved, however, by her ready
acquiescence in the loss of her wealth and by her
spirit of perfect unselfishness, he gave it back to
her, and she used it throughout her life in the most
lavish alms. Olympia was prominent during the
ministry of three bishops, Gregory Nazianzen,
who taught and helped her greatly, Nectarius,
who ordained her as deaconess, and Chrysostom.
The period of her activity in Constantinople is
regarded as the very zenith and flower of the work
and influence of the deaconess in the Eastern
Church, and the clergy speak of the deaconess of
that day as the joy of the Church.

The order was now distinctly ecclesiastical ; the
selection and control of the deaconesses lay entirely
in the hands of the bishop, and rich and noble
women were grateful for the privilege of entering

io6 A History of Nursing

this calling. It would appear that the staff of
deaconesses and other women workers under the
direction of Chrysostom, of whom there were
forty, lived a communistic life under the immediate
guidance of Olympia.1 It is a pity that Chrysos-
tom, as his letters sho\v, continually suggested to
his flock the less admirable motives of the merit of
austerity and bodily untidiness, the consciousness
of holiness and the hope of reward. Even
making allowances for the style of Oriental elo-
quence, the praise which he lavishes on the women
of his flock must have had a somewhat unwhole-
some effect if it did not disgust them. He reminds
Olympia in the most fervent manner of her many
good deeds and virtues, tells her to "be proud,
and rejoice in the hope of these crowns and re-
wards "; he praises her asceticisms, by which she
brought her body to such a state that, as he ex-
pressed it, 'it lies no better than slain ; and thou
hast brought upon thyself such a swarm of diseases
as to confound the physician's skill and the power
of medicine." More considerate of others than of
herself she sent drugs for his own use to (Jhrysos-
tom when he was in ill -health.

It is not very easy to reconcile the first pictures

of Olympia, the beautiful young wife of a Roman

prefect, with a later description of her appearance,

in one of this enthusiastic old man's letters to her:

'For I do marvel at the unspeakable coarseness

1 K. Gotz in Zimmer's Handbibliog. der -praktischen Theologie.
Dcr Diakonissenberuf, Gotha, 1890.

Women Workers of the Early Church 107

•

of thy attire, surpassing that of the very beggars;
but above all, at the shapelessness, the carelessness
of thy garments, of thy shoes, of thy walk; all
which things are virtue's colours." Again, Pal-
ladius, a contemporary, says of her, ' She ab-
stained from animal food, and went for the most
part unwashed . " 1

The widows and virgins, over whom the
deaconess at certain periods exercised some super-
vision, are also classed as orders of the clergy, 2
though of a lower rank than the deaconess, and
they were closely related to her in her duties, for
they appear to have shared extensively in the
work of relief and of nursing. Appointments to
the diaconate, moreover, were frequently made
from among the numbers of widows and virgins.
The qualifications of the widows who were to be
supported by the church are mentioned in i Tim,,
chapter v. From the first the church kept a list
of persons entitled to a fixed allowance from the
church funds. The list was called the matricula,
and included the clergy of both sexes, the conse-
crated virgins, the old, widowed, and poor.3
From among the widows thus maintained there
was a special ecclesiastical class or order enrolled
and ordained, called the Or do Viditarum or
viduate. This class, though only a small one in

1 Wheeler, op. cit., p. 122.

2 See Taker and Malleson, op. cit., part iv., The Ecclesias-
tical Orders.

3 Ibid., part iii., p. 203.

io8 A History of Nursing

•

any community, became one of great dignity.
The ecclesiastical widows presided over the
Christian assemblies, constituted a bench of women
elders, and taught. 1 To another and larger class
of widows belonged those who, holding the
thought of a second marriage in abhorrence,
took a vow to remain widows, and usuallv donned

some distinctive dress, though continuing to live
in their own homes. At first privately made,
such vows were later undertaken in the presence
of a bishop, though still privately, but still later
became a public function and the order became
merged with those of the monastrice, or nuns.
The widows were very active in good works, and
later, as we shall see, took a prominent part in the
development of hospitals. Haeser says of them:
"The widows at a very early time had an ex-
tensive and greatly blessed activity in the inner
life of the congregation."

In the mosaics on the walls of the ancient
churches at Ravenna stand, in white array, pro-
cessions of grave and charming damsels, the
Ecclesiastical Virgins, typical of the youthful
freshness and earnestness of the time.

Philip's four daughters, 'virgins, who did pro-
phesy," were perhaps among the first of the
early Christian virgins. According to Tuker and
Malleson, " the cult of virginity was one of the most
startling of all the unlikenesses between the newer

'Inker and Malleson, op. cit., part iv., pp. 517, 519

Women Workers of the Early Church 109

Christian and the old pagan society." l Only
with difficulty had the number of six Vestal
Virgins been kept up in Rome, but now groups of
virgins voluntarily formed themselves into com-
munities, first in Africa and the East, and later
in the West. The early consecrated virgins lived
at home, and moved about freely. There was at
first no suggestion that the widowT or maiden who
vowed continence need necessarily seek seclusion
or solitude.2 Helyot says, "Though the church
had always had holy virgins, they had not always
lived a communistic life," and Tuker and Malleson
say, " Enclosure formed no part of the life of the
canonical virgin of the early Church."3 But with
the close of the third century there were numerous
communities, and Gibbon speaks of the ' stately
and populous city of Oxyrinchus, which had
devoted the temples, the public edifices, and even
the ramparts, to pious and charitable uses, and
where the bishop of twelve churches could compute
10,000 female members . . . of the monastic
profession."4 But, although new in Rome, the spec-
tacle was not new to the ancient world, for in
Hindoo legends both Brahma and Buddha claim
long lines of monks and nuns.5 The sacred books

1 Op. cit., part iii., p. 15.

2 Women under Monasticism, by Lina Eckenstein, Univ.
Press., Cambridge, 1896, p. 14.

3 Op. cit., part iii., p. 41.

4 The Decline and Fall of the Roman Empire, vol. iv., p. 308.

5 Monks and Monasteries, Alfred Wesley Wishart, Trenton,
1902, p. 19.

no A History of Nursing

of Ceylon speak frequently of priestesses, even to
the number of thousands, and it would also
appear that this calling was sometimes at least
a voluntary one, and without irrevocable vows,
for one reference is made to a priestess who
married, "who had not so mortified herself as to
renounce the world."1 The Egyptians had many
priestesses or temple women ; ' the celibate com-
munities attached to the Egyptian temples were
of both sexes."2 Although few in number, the
Vestal Virgins enjoyed a rare dignity of position,
and in the Western World, in ancient Peru, the
Virgins of the Sun to a certain extent might claim
relationship with other religious communities of
women.3

The ecclesiastical or canonical virgin ranked
with the clergy. Unlike the deaconess the virgin
was not ordained, but was consecrated. :The
rite of consecration of a virgin is one of the oldest,
as it was one of the most important, in the prim-
itive church."4 She was distinguished by a white
veil, but in Rome the earliest distinguishing mark
of her dress was a gold fillet, the symbol of vir-
ginity. At a much later date a ring and bracelet
were added.5 The rank of the ecclesiastical
virgin, originally shared by both men and women,
exists to-day only in the consecrated nun, who is

1 Upham, op. cit., vol. 2, p. 121.

2 Tuker and Malleson, op. cit., part iii., p. 15.

3 See Prescott, Conquest of Peru, vol. i., p. 113.

4 Tuker and Malleson, part iii. p. 129.
s Ibid, part iii., p. 34.

Women Workers of the Early Church 1 1 1

her lineal descendant.1 Not the deaconess, but
the virgin and widow, were merged in the nun.2
The order of deaconesses did not become monastic,
but died away, and the convent replaced it.
Syncletia, the sister of Pachomius, who was the
first to introduce a monastic rule, is sometimes
called the Mother of Nuns. Reputed to have
been wealthy, noble, and beautiful, and reared by
very pious parents, she, with her sister, dwelt for
years in a tomb near Alexandria, where she taught
the 'many widows and virgins' who came to
learn from her and eventually formed a commun-
ity around her.

The titles of deaconess, widow, and virgin are
used with perplexing indefiniteness in many old
writings, but it is clear that the form of ordination
or of consecration used in each case can alone
define the differences. For widows and virgins
might become deaconesses. Further, as the Ro-
man title Widow did riot mean a widow in fact,
but was a general title of age and dignity, young
women and even young girls were admitted to the
viduate. Tuker and Malleson state that by the
sixth or seventh century the rite used was a com-
pound of the consecration of a widow-nun and

1 Tuker and Malleson, part iii., p. 16.

2 Tuker and Malleson state (part iii., p. 108) that the Car-
thusian nuns still retain, in the form of consecration after
four years of profession, the ancient Christian rite of Ordina-
tion of Deaconesses, joined to the rite of Consecration of a
Virgin, as a relic of their first rule, — that of St. Cesarius of
Aries. These are the only nuns who have kept it.

ii2 A History of Nursing

the ordination of a deaconess ; that by such a form
the Prankish and Saxon widows or nun-deacon-
esses were consecrated, and that thus the title
remained long after the ecclesiastical office had
ceased.

The spheres of activity both of deaconess and
widow were gradually limited and curtailed by
the ever-vigilant reluctance of men to admit
women to positions of authority. The widows
were the first to feel the pressure. Schafer says:1

The widow had at first been called the Altar of God :
she taught and expounded the faith. Toward the
third century she was jealously and continually forbid-
den public teaching, and every attempt to develop
into the higher positions, or province of men, was rig-
orously put down. The Apostolic Constitutions make
clear the suppression of the widow's function of
teaching and assign her a role of humility and
submissiveness, modest stillness, gentleness, and
homekeeping. She was to sing, pray, read, watch
and fast, spin wool and make gifts of it.

Schafer continues:

The evolution of the third century was unfavourable
to the widows and their office. As regarded the
'selected" or "appointed" widows of the older insti-
tution of widows, who, as the eldest, occupied a fore-
most position among women and were teachers of the
younger ones, there was developed an uncertainty
in their relation to the priestly function. Tertullian

1 Op. cit., vol. i., pp. 41-44.

Women Workers of the Early Church 1 1 3

and Origen found it necessary to remind them of the
lawful limitations of women's work and position. The
deaconesses, on the contrary, were much better
adapted to a hierarchal order. They did not, like
the older women, assume a lofty position. They
were servers. The choice of the deaconess lay en-
tirely in the hands of the bishops, while the choice
of widows, as prescribed by the apostle, could not be
so controlled, as it had to depend on the conditions.
If a widow was suitable and her circumstances such
as the apostle had mentioned she could not but be
admitted. The deaconess was in much stricter
subordination to the clergy.1

It is easy to guess from all this that the widows
sometimes crossed the priestly paths in regard
to the details and practical management of their
work — undoubtedly often having superior know-
ledge and experience, and they probably often
had to contest, or even refuse, the directions they
received.

But the democracy of the early Church had given
the deaconess also too large a sphere. The promi-
nence of women permitted by the Montanists,
a sect that had women as bishops and presbyters,
and the extraordinary claims made by some of
these women who posed as prophetesses, and
assumed a place in the Church in every respect
equal to that of men, naturally came to be strongly
opposed by the clergy, especially in regard to
their giving the sacrament, and the female dia-

1 Op, cit ., vol. i p. 47.
8

T 14 A History of Nursing

conate thereby became somewhat discredited. In
the Western Church (Rome) deaconesses were
abolished so early that by the year 251 the Roman
parishes had no more female clergy. The wid-
ows who continue to be mentioned were the
objects of church charity, and were employed to
visit the sick. Ambrosius declared it to be a
Montanistic error for women to exercise churchly
functions; though the order of deaconesses con-
tinued in the Eastern Church, and though among
the Priscillianists deaconesses played an important
role, new priestly rules and edicts were continually
appearing to limit and repress their functions. l
With the spiritual repression came also the eco-
nomic compulsion. In the sixth century appeared
edicts forbidding the deaconess to marry, or even
to choose any other mode of life, under penalty of
death, and providing for the confiscation of her
property in such case, for the use of the church
or convent to which she had belonged.2

The female diaconate lasted in the East as an
institution until the eighth century, but Schafer
says that from the end of the fourth it steadily
declined in importance. It was deprived of its
clerical character by the decrees passed by the
Gallic councils of the fifth and sixth centuries.
It was finally entirely abolished as a church order

1 Real-Rncyklopddie fur protestantische Theologie und
Kirche (Herzog and Hauck, Leipzig, 1898), art., " Dia-
konissen," von Hans Achelis.

2 See Wheeler, op. cit., p. 86.

Women Workers of the Early Church 115

by the Synod of Orleans, 533 A.D., which forbade
any woman henceforth to be ordained as a deacon-
ess. True, this ruling was often ignored, and dea-
conesses continued to survive in some parishes,
even in France. About the year 600 A.D. the Patri-
arch of Constantinople, godfather of the Emperor
Mauritius, built for his sister, who was a deacon-
ess, a church which for centuries was called the
Church of the Deaconesses. In 670 the Council of
Autun forbade women to ascend to the altar.
In the twelfth century there were still deaconesses
at Constantinople, who were spoken of by the
Patriarch of Antioch as ''Virgins . . . consecrated
to God, except that they wore the garb of the
laity . . . and at forty years old they received
ordination as deaconesses."

The order of deaconesses of the early Christian
Church may be well contemplated with affectionate
respect as having laid the foundations of the nurses'
calling and of all modern works of charity. Prob-
ably no sweeter examples of lives spontaneously
spent in loving service are to be found in the world
than those of the workers of the early Christian
Church, while the pure glow of the Master's teach-
ing was yet undimmed, and before worldly am-
bition and selfishness had crept in. After her
waning, many looked back upon the primitive dea-
coness as the type and pattern of excellence
in good works, and in subsequent efforts to return
to simpler forms of faith, such as those of various
sects, there was always some attempt made to

n6 A History of Nursing

recall her into activity. So, too, Vincent de Paul,
single-hearted and devoted, held up to the Sisters
of Charity the ideal of the women of the apostolic
church as their pattern. Authorities differ as to
whether Luther was in favour of such a revival, but
it seems conclusive that, although he was liberally
disposed toward such work for women, he did not
urge it. As his time there was great prejudice
against churchly orders. In the century after
Luther other sects returned to the primitive order
of deaconesses, as we shall later see, and it was
this yearning that prompted the Kaiserswerth
revival of the work of the deaconess, which, through
Miss Nightingale, influenced so directly and strik-
ingly the development of modern secular nursing.
There has been no more attractive subject than
the deaconess for the controversy of learned pas-
tors. Shelves full of books have been written upon
her, proving what she was, and what she was not;
what she ought to be, what she might be; what
she did and what she did not do; that she did
preach, and that she did not; that she officiated
at the altar, and that she did not; that she was
but a poor copy of the nun, and that the two were
as far apart as the poles. Nor has any woman
received more eulogistic praise and encomiums.
Pastor Wilhelm Lohe wrote of her as follows:

I am neither a painter nor a singer; if I were I
would paint the deaconess as she is in her various
occupations and life works. There should be a row
of pictures and as many songs. I would paint the

Women Workers of the Early Church 1 1 7

deaconess in the stable, and at the altar; in the
laundry, and when she clothes the naked in the
clean linen of pity; in the kitchen, and in the hospital
ward; in the field, and with the thrice holy in the
choir, and when she alone with the communicant
sings the Nunc Dimittis. I wrould paint all possible
pictures of the vocation of deaconess, and why? Be-
cause she can do and does do the least and the greatest.
She is not ashamed of the lowliest service and she
does not fail in the highest. Her feet in the mire
and dust of lowly work; her- hands on the harp; her
head in the sunlight of prayer and the knowledge of
God. So would I place her on the title page of the
whole collection and underneath I would write:
' Labour can she — and make sweet music — and sing
praises. '

When we add to this characteristic picture of a
man's conception of the possibilities of work for
one woman the crowning advantage — that this
all-useful woman was entirely under masculine
control, almost without wish or purpose of her
own — it is easy to understand the eulogies and
the encomiums.

CHAPTER II

EARLY HOSPITALS AND THE ROMAN MATRONS

THE early Christians, following the ancient sa-
cred custom of hospitality with the new mo-
tive of loving service added, held their goods in
common and opened their houses freely to the' sick
and destitute. The deacons and deaconesses were
especially zealous in seeking out cases of need, and
not only nursed the sick by a system of visiting
nursing, but brought them when necessary into
their own homes to be cared for. The bishops,
who were natural centres towards whom the
afflicted gravitated, kept open house, and wealthy
or \vell-to-do members of their congregations
followed their example. This was the simple
original form of the modern hospital and of all
other varieties of charitable institutions. The
diakonias, as these organised home hospitals soon
came to be called, associated the diaconate with
the work of nursing, so much that the term dia-
konus came later to be synonymous with hospital
or nursing director. As late as the ninth century
Rome still had twenty-four such diakonia, and

118

Early Hospitals and Roman Matrons 119

many of them remained until modern times under
the name of the church with which they were
connected.1

With the growth of the congregations the poor
flocked to them, and the gradual abolition of
slavery, the oncoming of persecution, martyrdoms
and outward enmity created a mass of misery far
beyond anything that individual efforts could
overcome, and which therefore, required the united
help of all. As the homes of bishops became too
small to meet the demands of hospitality, new
apartments, wings, and cloisters were added to
them. Thus simply and naturally grew up the
Christian xenodochium, or home for strangers,
the expression of brotherly love, and the descend-
ant of the ancient institution which had been the
expression of civic hospitality. Haeser mentions
an interesting example of this growth of the houre
of the clergy in Wiirzburg, where attached to the
cathedral is the episcopal dwelling, still showing the
two ancient divisions into the " domus hospitum,"
and the " domus hospitalis " ; or the separate apart-
ments for the ordinary traveller, and for those who
were sick or poor.2 The evolution, then, of the
earliest forms of Christian care of the sick was:
diakonia, or rooms in private houses; xenodochia,
amplifications of the diakonia; and finally, hos-
pitals; while the forms of the earliest nursing or-
ganisations, beginning in the congregation, passed

1 Haeser, op. cit. p. 9,

2 Ibid., p. 14.

i2o A History of Nursing

through the diacohate, the widows' sisterhoods,
the parabolani, to monks and nuns.

One of the earliest known instances of nursing
in the noble struggle against misery waged by the
early Christians was during a violent pestilence in
Alexandria between the years 24gand263 A.D. This,
says Hecker, was the last extensive epidemic of
the antique or Thucydidian pest, which presented
a group of symptoms not repeated in later epi-
demics. (He also mentions, though without
nursing details, a similar earlier one in Carthage.) !
At this time of public calamity the Christians,
regardless of the danger to their own lives, visited,
relieved, and attended the sick and comforted the
dying. St. Dionysius said, Thus the best of our
brethren have departed this life : some of the
most valuable both of priests, deacons, and laics."2
Another notable instance was connected with a
frightful epidemic in Edessa, about the year 350
A.D. The inhabitants were in despair, and the
wealthy citizens, though willing to give freely of
their means to stay or mitigate the plague, knew of
no honest or capable agent to undertake the relief.
In this extremity came out of his retirement
Ephrem — a deacon of Edessa, who, though he
was the greatest orator and poet of the Syrian
church, had gone to the desert as a 'solitary'

-and offered his services. With the money

1 Die Ur sprung Christlicher Krankenpftege. Medicinische
Zeitung, Berlin, May, 1834, p. 97.

1 Butler's Lives of the Saints, vol. ii., p. 274.

Early Hospitals and Roman Matrons 121

poured into his hands by the rich citizens he
bought three hundred beds and placed them in
the public porticoes and galleries. The sick were
brought thither, and Ephrem "visited them every
day and served them with his own hands," 1 ad-
ministered the funds and controlled the* situation
until the plague had passed. This account is of
special interest, for St. Ephrem here evidently
established hospital wards pure and simple, and
certainly one of the earliest, if not the very earliest
hospitals in the strict sense as the term is used
to-day; for, as we shall see, the hospital, as a
building or set of buildings devoted entirely to the
care of the sick only, did not become a separate
entity much before the twelfth century, but long
remained one of the many divisions of the all-
embracing xenodochium. Even the earliest hos-
pitals not only took the sick and the poor, but
often cared for foundlings as well. But St.
Ephrem' s foundation remained, and with some
breaks in its history was continued as a hospital.
In the fifth century it was restored by Bishop
Rabboula, having fallen into decay. The bishop
also erected a large hospital for women, having
demolished four pagan temples for this purpose,
and these two hospitals furnished the clinics for
a famous medical school which long flourished in
Edessa.2

The xenodochium in its perfection represented

1 Butler's Lives of the Saints, vol. vii., p. 98.

2 Withington, op. cit., p. 120-125.

122 A History of Nursing

the ideal of hospitality in rich and amazing ampli-
tude. As the work of the deaconess comprised in
itself the elements of all modern lines of nursing,
relief association, and charity organisation work,
so the xenodochium demonstrated in its friendly
precincts -the primary stage of the modern inn, the
hospital, and every form of specialised institution
for every class of dependent. It had rooms for
the pilgrim and for the merchant of ample means.
It was a home for the homeless; it sheltered
foundlings, young children, widows, and aged per-
sons of both sexes. It had wards or separate
buildings for the sick of every variety, especially
for the lepers and the insane. The poor of the
region round came daily for doles and alms, and
every one who was in distress of any kind came
for counsel.1 As an example of the work done by
the xenodochium, Chrysostom says that in the
year 347 the churches in Constantinople fed daily
three thousand poor, besides caring for prisoners,
wanderers, and the distressed and afflicted of every
kind. Such refuges or shelters, developing from
the hospitality of the bishop or deacon, were
already fairly well organised by the middle of the
third century, and put in charge of deacons and

1 The names of the various special divisions, several or all
of which were found in the great charitable institutions of
the early centuries were: The Xenodochia, inns for strangers
or travellers; Nosocomia, wards or rooms for sick; Brephotro-
phia, foundling asylums; Orphanotro-phia, orphan asylums;
Gerontokomia, homes for the aged men; Cherotrophia, homes
for widows; Ptochotrophia, alms-houses for the poor.

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Early Hospitals and Roman Matrons 123

deaconesses. The most famed of all the early
institutions was the notable hospital (as we will
call it, also sometimes called a xenodochium and
again a ptochotrophium) established by Basil,
bishop of Cesarea, in his diocese in the year 369 or
370 A.D,, and named, after him, the Basilias.
The urgent needs of the numerous lepers in Asia
Minor had prompted him to its building, and
the great famine of 368, with its resulting mis-
ery, hastened its execution, Gregory Nazianzen,
Basil's friend, said of the Basilias, ' It would be
reckoned among the miracles of the world, so
numerous were the poor and sick that came hither
and so admirable was the care and order with
which they were served." 1 ' Before the gates of
Cesarea," he wrote, 'called by Basilius out of
nothing, rose a new city devoted to works of
charity and to nursing the sick. Well-built and
furnished houses stood on both sides of streets
symmetrically laid about the church, and con-
tained the rooms for the sick and the infirm of
every variety, who were entrusted to the care of
doctors and nurses." There were separate build-
ings for strangers, for the poor, and for the sick,
and comfortable dwellings for the physicians and
nurses. A large and important division was for the
lepers, whose care was a prominent feature in
Basil's work. ' Basilius, who belonged to a noble
family, and who in his youth had never known
hardship, gave the lepers his hand, embraced them,

1 Butler's Lives, vol. vi., p. 207.

124 A History of Nursing

assured them by a kiss of brotherhood of his sup-
port, and himself attended them in their wards."
The staff was divided into nurses (nosocomi),
doctors (bajuli), carriers (ductores), and artisans
(artifices) . The ductores (later called parabolani)
went out to seek the sick and carried them to the
hospital. The artisans comprised every kind of
handworker or craftsman, for in those days almost
everything needed for the whole vast institution
family was made upon the grounds.1 This xeno-
dochium became the model for many charitable
persons, and emperors and bishops hastened to
erect others. Already Constantine (272-337 A.D)
and his mother, Helena, had built shelters for
strangers and pilgrims, and under Justinian
(527-567 A.D.,) the zeal in building xenodochia
was at its height. The care of lepers was made a
specialty in Basil's hospital-city and it has even
been thought possible that the earliest knightly
nursing order, that of St. Lazarus, arose from the
service in the Basilias. It is evident that serious
medical care was given by Basil, for Gregory
Nazianzen speaks of disease being ' investigated '
and "symptoms proved." By his wonderful work
in this institution Basil excited the jealousy of his
enemies, and was accused by the prefect of Cesarea
of seeking to make himself unduly powerful. In
defending himself he said: 'Whom do we injure
in building lodgings for the strangers who stay

1 See Hecker, op. cit., pp. 97-98; also Schafer op. tit., vol.
ii., pp. 134-135; and Haeser, op. cit., pp. 15-16.

Early Hospitals and Roman Matrons 125

with us in passing through the country, and for
those who need attendance in consequence of
infirmity? Is it a crime to supply necessary com-
forts for these persons; nurses, medical attend-
ants, means of conveying them, and persons to
take charge of them in removal ? And these things
must of necessity carry with them handicrafts,
and these again, work-shops." 1 Basil's eloquence
and charity overcame the opposition of jealous
officials, and he encouraged the building of similar
institutions in every diocese, with special regard
to the lepers. He commended the care of the sick
to the clergy, but also lost no opportunity of
gaining the sympathy and co-operation of the
secular officials, well knowing how important was
the support of the laity. He succeeded in per-
suading the civil authorities to remit the taxation
of the hospitals, after bringing them in person to
see for themselves the good that was being done.2
Basil, one of the four Greek Fathers of the
Church, born about 329 A.D., was one of a notable
family. His grandmother Macrina, who was a
woman of great attainments, gave him his early
education. He studied afterwards in Athens, and
beside great general learning he is said to have
acquired there a general knowledge of Greek
medicine. Hecker says of him that he had a pro-

1 Diet. Christian Antiquities, art., " Hospitals," quoting Ba-
sil's Letters.

2 Die Bilrgerliche Gesellschaft i. d. alt. Romischen Welt.,
C. Schmidt from French of A. V. Richard, Leipzig, 1857.

A History of Nursing

found knowledge of Greek science, uniting Hippo-
cratic medical lore with Christian love and pity.1
His sister was Macrina, the beautiful girl and
friend of Olympia, of whom several different
stories are told. Brought up with great care by a
pious mother, and early betrothed, the untimely
death of her fiance caused her to devote herself to
heaven. The capable elder of a flock of nine,
she managed large estates after her father's death
and helped to rear her brothers and sisters,
finally founding monasteries on her own land, in
one of which she lived. It was she who turned
Basil to a religious life.2 Macrina is counted by
Protestant writers as a deaconess, but Helyot
places her among monastic women. She wras both,
having been early ordained as a deaconess, and
later withdrawing to a convent which she founded
with her own fortune on the river Iris, where she
gathered a community about her. Basil wrote
their rule, allowing them to visit their relatives
in illness and to receive visits from women.
They acted as nurses to their own people, or re-
ceived patients in the convent, or both; for Helyot
remarks that, although their rules allowed them to
bathe only once a month, the patients were to be
bathed as often as the doctor ordered. So ideal
was Macrina 's character, so lofty and fine her
intellect, and so pure her life, that writers of the
most opposite religious schools claim her. Schafer

' Op. cit., p. 95.

2 Tuker and Malleson, op. cit., part iii., p. 64.

Early Hospitals and Roman Matrons 127

places her next to Olympia in distinction, and
remarks that, although in her mode of life she
was distinctly monastic, yet hers was conventual
life in its purest form.1

Another early hospital in the East \vas that
founded by St. John Chrysostom at Constanti-
nople in 398 A.D., spoken of by Palladius. It was
large and ample, composed of many buildings, and
supplied with physicians, cooks, and attendants.
Of all subsequent xenodochia in the East, the
most notable was one founded in Constantinople
in the eleventh century by the Emperor Alexius,
and called the Orphan House. The name, how-
ever, simply accented its most prominent specialty,
for every other form of relief was carried on in it
as in the earlier institutions. It was as large as a
small city, accommodating about 10,000 persons2
and was filled with the sick and needy of every age,
sort, religion, and nationality. Here the care of

1 Schafer, vol. L, p. 280-282, quotes Rolling, who places
Macrina next to Mary as having left an unexampled impress
of her spiritual nature on the life of the world. He instances
especially the intellectual and religious influence which she
wielded over her brilliant and learned brothers. Bohringer
also called her explicitly "the spiritual head of her family."
Kolling thinks her community life presented an original
of Kaiserswerth, and that its vigour lay in the fact that,
while her band of virgins lived an utterly unworldly life, yet
the roots which bound them to the realities of life were not
cut. But Schafer thinks he overlooks in this comparison
the fact that they relegated active work to the background.

2 Etudes historiques sur Vinftuence de la charite durant
les premiers Siecles Chretiens. Etienne Chastel, Paris, 1853.

128 A History of Nursing

the sick was entirely in the hands of the clergy and
religious orders. No mention of physicians is
made, but the Brothers and Sisters made use
of prescriptions written by Greek physicians, of
which the collection of the physician Niketas was
the most important.1 About this time, Constan-
tinople had altogether some thirty-seven different
institutions, of which the greater number dated
from the early centuries.

One set of persons connected with the early
care of the sick quickly gained an undesirable
reputation and had a stormy history. These
were the ductores or carriers, later called parabo-
lani, members of a monkish order, belonging, in an
inferior capacity, to the clergy. The parabolanus
was on the staff of all the old xenodochia as a
guide or escort for the patients. There is some
dissension among authorities as to the exact
• derivation of this title. Some trace it to a deri-
vative meaning " to go into danger, as of infection,"
but Heusinger, whose conclusions are based on
thorough study, gives; "to bring or carry.' His
chief duty was to go forth, look for the needy
sick, and bring them into the hospital,2 perhaps
with some kind of conveyance or primitive
ambulance, or in his arms; in short, his functions
combined those of an ambulance driver and a

1 Haeser, op. cit., p. 18, and Anmerkungen, p. 103.

2 Die Parabolanen oder Parapemponten der alien Xenodo-
chien, by C. F. Heusinger in Janus: Zeitschrift fur die Ge-
schichte der Litteratur der Medizin, Breslau, 1847, ii., pp.

500-525.

Early Hospitals and Roman Matrons 129

first aid messenger. The parabolani are first
mentioned in the latter part of Basil's pontifi-
cate, when Basil, writing to Hilias, speaks of the
"nurses and doctors, the beasts of burden, and
the guides sent out to the people. ' In character
they appear to have been generally ruffians,
drawn from the hordes of Syrian and Egyptian
monks of a rough and lawless type, who then
swarmed over the country. It was a mob of these
brutal monks that murdered Hypatia. * They were
a terror in Alexandria wrhen Christianity was
made the religion of the state in 391, and became
continually more and more degenerate. Gibbon
speaks of " 600 Parabolani or adventurers," who
" visited the sick at Alexandria. ' A number of
measures were passed designed to subdue them.
The Theodosian code said of them: "As to the
nurses [parabolani] consecrated to the service of
the sick, we command that they shall be estab-
lished to the number of 600. They shall be
selected from among those who have gained most
experience in this kind of service. They shall be
chosen by the bishop of Alexandria, and shall
act under his order and conform to the regulations
that he shall make. ' This restriction of numbers
was to place a check on an association which they
had formed among themselves and to keep them
under control. They were forbidden to go to the
theatre or to frequent public places, where their

1 See Hypatia, by Charles Kingsley.

2 Op. cit., vol. viii., p. 32.

i3° A History of Nursing

shameless behaviour, coarseness, and violence
made them notorious, and efforts were made to
stop bribery among them and to prevent them
from selling their positions. Their errands, which
took them into the worst parts of the towns,
acquainted them with all the dregs of humanity;
moreover, as they had some knowledge of first
aid they became quacks, and used their position
to extort money from the people. In spite of
repressive legislation they became more and
more depraved, and were utilised by Diascuros of
Alexandria to murder one of his opponents at the
Council of Ephesus.1 By the first half of the
fifth century they were lost sight of.

Alexandria had many hospitals and institu-
tions, as may be judged by the number of the
parabolani. It was probably not always easier to
get money to support them then, than to-day,
and Chastel repeats a pleasant little story of
Macarius, the head of an Alexandrian hospital,
who conceived the idea of getting a very rich,
jewel-loving, and avaricious lady to give him
500 pieces of gold for some wonderful jewels which
he told her he could procure. She was to come
to him on a certain day to receive them. When
the day and the lady arrived, the worthy Macarius
showed her with pride a long hospital ward, where
lay her "jewels" each one tucked snugly in a bed.
The lady was gracious enough to take his stratagem
in good part.

1 Heusinger, op. cit.

Early Hospitals and Roman Matrons 131

To give, in a small space, a just review of the
social conditions of imperial Rome, at the time
when the history of nursing brings us there,
would be, perhaps, even more impossible than
to attempt a condensed but true account of any
vast modern city. The spectacular depravities
of ancient Rome, the hideous cruelty of her public
amusements, the orgies of the rich, and the mis-
eries of the slaves have been frequently recounted,
as a prelude to the description of hospitals and
nursing established by the early Christians.
And, whenever the story is told briefly, these
revolting details are usually the only ones to be
considered. But it is only fair to remember that
there were other elements and currents in the life
of the Roman world. Moreover, the light of
Christ's teachings in no way requires the setting
of an exaggerated pagan darkness that many
writers have appeared to think necessary as a
contrast. Lecky l shows how the greater human-
ity of the Greeks modified and softened in certain
directions the hard Roman nature; he reminds us
that the slaves could purchase their freedom, and
that many obtained it in this way ; he recalls the
noble ethics of the Stoic philosophy, which also
taught human brotherhood, as best exemplified
in the lives and writings of the great Stoics.
' Men, ' wrote Cicero, ' were born for the sake of
men, that each should assist the others. ' Dill
writes : " If [Roman] society had been half as

1 Op. cit., vol. i., pp. 227-228.

132 A History of Nursing

corrupt as it was represented by Juvenal, it must
have speedily perished of mere rottenness. Yet
when Juvenal died Rome was entering upon a
period of upright administration and high public
virtue. ' Gibbon reckons the period of time
between the reigns of Nerva (96 A.D.) and Con-
stantine, up to the end of the latter (337 A.D.), as
probably the happiest in the history of the
empire, if not indeed of the world. But the
nobler vistas of thought were closed to the masses
of the people. Knowledge and enlightenment
were exclusive, enjoyed only by a small minority,
not open to the people at large. In Rome itself,
the culture of the few could not withstand the
gradual brutalisation of the masses, and moral
bankruptcy followed, as the ruin of agriculture
and the obliteration of the middle class followed
the combination of aristocracy and slavery in the
empire at large.1 Tuker and Malleson write:

The imperial system afforded no role for the
individual citizen, who suffered perforce the curse
of idleness. . . Men's faculties could not be em-
ployed, could not develop happily or harmoniously;
human nature was thwarted and hence warped.2
Into this society came the teachings of Chris-
tianity [not yet, after nearly two thousand years,
generally accepted in practice,] to undermine sla-
very in every form and to teach the truth which
should set men free. That self-dependence and

1 On this see Villari; also Lecky, op. cit., vol. i., pp. 256—268.
3 Op. cit., part iii., p. 3.

Early Hospitals and Roman Matrons 133

sense of personal responsibility for which there was
no place in the old Roman system, had become
paramount facts for the Christian: with him a new
art had been born into the world, " the art of self-
direction," and inevitably he was led to another new
thing — the experience of himself as an individual.1

. . . Did Phebe start the work of the
deaconesses in Rome when she made her visit
there, taking with her the letter from St. Paul to
his friends? Nothing could be more probable,
although there are absolutely no records to
support the idea. But it would be just as un-
reasonable to suppose that she could visit Rome
and confer with the believers there, devoted as
she was to the works of <;i succour, " without trying
to further and develop the diaconate, as that Mrs.
Fry could, eighteen centuries after, visit Paris
and Brussels without urging the works of human-
ity which were nearest to her heart. We must
suppose that the deacons, deaconesses, and widows
of the Church followed the same lines of visiting
nursing work and the opening of small charity
hospitals in private homes in Rome, as in the East ;
but no names of such workers have been handed
down until, toward the middle of the fourth
century, we come upon those of that noble group
of Roman matrons whose distinguished positions
as descendants of the oldest and most patriotic
Roman families, and whose learning and personal

i Op. dt., pp. 5-6.

i34 A History of Nursing

gifts of character, with the great deeds that they
wrought in establishing Christianity, founding
hospitals and convents, and forwarding education,
have placed them high in the list of great
women. The names and histories of Marcella,
Paula, with her daughters Eustochia and Blesilla,
Proba and her daughter Laeta, Lucina, Fabiola,
Principia, Asella, Lea, Melania, Albina, and others,
some fifteen in all, have been preserved in the
writings of Jerome. Chastel mentions, beside
Fabiola, the virgin Demetriada, Eupraxia, and a
second Melania, who divided all their property
among the poor. As early as the second century
Roman converts to Christianity had turned their
houses into hospitals and centres of alms-giving.
Gibbon speaks of the senators, but more especially
of the matrons, who thus transformed their
palaces and villas.1

The motives which of old led individuals into
nursing were perhaps more varied than those at
work to-day, when social conditions are more
prosaic and the average man and woman rather
more mediocre. With the dawn of Christianitv

•/

nursing took a high place as a penance for sins
and a solace for unhappy lives. Chastel in his
Influence of Charity speaks of the 'volunteers,
sometimes happy but often unhappy persons, who,
beside the deaconesses and widows, turned to
nursing in the hospitals. ' He tells of a young girl,
who, having been cruelly seduced, gave thirty

1 Op. cit., vol. iv., p. 308.

Early Hospitals and Roman Matrons 135

years of service to the sick in expiation and
atonement, and refers to the advice given by St.
Anthony to a Brother, who was inclined to melan-
choly, that he should take up nursing. The
Roman patricians who took a part in this move-
ment preserved their civil characters,1 for the
rumours and occasional sight of the unwashed and
slatternly monks of the Eastern Empire, who made
a cult of dirt, filled the fastidiously cleanly Roman,
whose cult had hitherto been personal daintiness,
with disgust, and religious orders were looked down
upon in Rome.

It was different with some of the members of
the group of exalted matrons, of whom mention
has been made. Their independent positions and
great wealth (for they were of those who, under
the free-marriage contract, preserved their legal
and personal dignity) were wholly utilised to
establish community life and to organise large
foundations for charity and nursing work. Mar-
cella was the chief and the leader of this group
of notable women. Her palace was on the Aven-
tine in the most exclusive part of Rome, and not
long ago Lanciani stood on the recently excavated
site of the garden which once surrounded it and
recalled her tragic story.2 The accounts which
she hacl heard of the monastic life, far from

1 LesGardes-MaladesCongreganistes,Mercenaires, Amateurs,
Professionnelles, by Mile. Dr. Hamilton and Dr. Felix Reg-
nault, Paris, Vigot Freres, 1901, p. 6.

2 The Destruction of Ancient Rome, by Rodolfo Lanciani,
London, 1903, pp. 58-60.

136 A History of Nursing

repelling, attracted her strongly. Full of zeal she
turned her palace into a monastery, thus intro-
ducing the first example of monastic life in Rome.
She was deeply learned, and when she became
acquainted with Jerome he wrote, 'All that I
have learned with great study and long meditation
she learned also, but with great facility and
without giving up any of her other occupations
or neglecting any of her pursuits.' Jerome, in
one of his letters, describes her life, her intellectual
ability, and her death. ' How much virtue and
ability, how much holiness and purity, I found in
her I am afraid to say. "* She was often consulted
by priests and bishops about obscure points in
the Scriptures and excited their admiration by
the acuteness of her judgment. During the sack
of Rome Marcella's house was entered by the
barbarians and she herself wTas cruelly beaten
and injured. She is believed to have taken
refuge in St. Paul's church beyond the walls,
where her death occurred as the result of her
injuries.

One of the most charming, and perhaps in
her younger days one of the most worldly, of
the group was Fabiola,. She was one of
the patrician Fabian family; had married a
profligate husband, divorced him, and married a

1 Letter to Principia. See A Select Library of Nicene and
Post-Nicene Fathers of the Christian Church, Schaff and
Wace, Second Series, 1893, New York, Oxford, and London,
vol. vi., Letters of St. Jerome.

Early Hospitals and Roman Matrons 137

second tiire, again unhappily. The influence of
Marcella, the teachings of Christianity, and,
perhaps, her own unhappy experience of life's
disillusionments, led Fabiola to throw herself,
with all the ardour of an animated, eager, and
restless nature, into a life of self-renunciation
and service to others. She became a Christian, and
then, in expiation of her former life and second
marriage, which she now regarded as a sin, she
made public confession, according to the emotional
and picturesque custom of that day. On Easter
Eve, criminals of all kinds and of the lowest
types came to the porch of the Lateran and openly
confessed their sins. Among them, to the amaze-
ment of all, stood Fabiola, the high-bred and
wealthy patrician lady, in a plain dark robe,
with her hair hanging down, ashes on her head,
and her face stained with weeping. Thenceforth
she lavished her fortune, which was princely,
and her energy, which was boundless, upon the
poor and sick. It was Fabiola who, in 390 A.D., built
the first general, public hospital in Rome, which
St. Jerome speaks of as a " nosocomium' -a place
for the sick as distinguished from objects of charity
who wrere simply poor. Jerome's famous eulogy
upon Fabiola, after her death, relates the whole
story of her life and works1- -her early worldli-
ness, her repentance, her activity in the hospital,
where she devoted herself to working as a nurse
among her patients.

1 Op. cit., letter Ixxvii., " To Oceanus."

A History of Nursing

Jerome thus describes her service:

There she gathered together all the sick from the
highways and streets, and herself nursed the un-
happy, emaciated victims of hunger and disease.
Can I describe here the varied scourges which afflict
human beings? — the mutilated, blinded countenances,
the partially destroyed limbs, the livid hands, swollen
bodies, and wasted extremities? . . . How often have
I seen her carrying in her arms these piteous, dirty,
and revolting victims of a frightful malady! How
often have I seen her wash wounds whose fetid odour
prevented every one else from even looking at them!
She fed the sick with her own hands, and revived the
dying with small and frequent portions of nourish-
ment. I know that many wealthy persons cannot
overcome the repugnance caused by such works of
charity; ... I do not judge them, . . . but, if I
had a hundred tongues and a clarion voice I could
not enumerate the number of patients for whom
Fabiola provided solace and care. The poor who
were well envied those who were sick.

Fabiola's friend Paula, and Pammachius, the
son-in-law of Paula, were deeply interested
in the hospital work, and shared sympa-
thetically in its foundation and growth, for
Paula herself had even earlier engaged in
similar undertakings in the Eastern Empire.
Fabiola and Pammachius co-operated in founding
an immense shelter for pilgrims and strangers
at Portus (Ostia), of which Jerome wrrote to
Pammachius, ' I hear that you have erected a
hospice for strangers at Portus, and that you have

Early Hospitals and Roman Matrons 139

planted a twig from the tree of Abraham on the
Ausonian shore."1 In his eulogy he referred
to a friendly rivalry between Pammachius and
Fabiola over this hospice, to see which could
do the most for it, and wrote: ;<A house was
purchased to serve as a shelter, and a crowd
flocked into it. ... What Publius once did in
the Isle of Malta for one apostle Fabiola and
Pammachius have done over and over again for
larger numbers. . . . The whole world knows
that a home for strangers has been established
at Portus. Britain has learned in the summer
what Egypt and Parthia knew in the spring."2
This hospice is mentioned by some writers as a
home for convalescent patients, a supposition
which Haeser explains by the use of the Latin
phrase villa languentium used in translations.3

Paula, born in 347 A.D., was one of the most
nobly born, highly gifted, and learned women
of her day. She was a descendant of Agamem-
non, of the Scipios, and the Gracchi. She was
enormously wealthy, the whole city of Necropolis
being her property. She was a Hebrew scholar
and assisted St. Jerome in his translations of
the prophets. The exhortations of Marcella won
Paula to Christianity and, after the death of her
husband, she entered Marcella 's house, then a
monastery, and was intimately associated with

1 Nicene and Post-Nicene Fathers, letter Ixvi., p. 138.

2 Ibid, letter Ixxvii.

3 Op. cit.t Anmerk., p. 107.

140 A History of Nursing

Fabiola and others of Jerome's ' noble ladies. '
After the death of two daughters, Paula, accom-
panied by one remaining unmarried daughter,
in fulfilment of a long-cherished, ardent wish
of both, left Rome about 385 A.D., and sailed
for Palestine, where they settled in Bethlehem.
Gibbon, in repeating the story, alludes with
sarcasm to her as abandoning her infant son.
As a matter of fact he was not, however, an infant
but a boy of ten, left in the care of affectionate
relatives ; and, unnatural though the action may
seem to us, it must be remembered that the
exaltation of self-sacrifice of that dav was deemed

a noble thing, and Jerome frankly encouraged
the breaking of the tenderest family ties. Paula,
of deep, serious, and lofty nature, could not have
taken such a step lightly. She and her daughter
founded a monastery in Bethlehem, where they
gathered about them a company of devout women .
On the road to Bethlehem Paula built hospices
for pilgrims and hospitals for the sick, in which
she and her staff served untiringly. Lecky says
she also established a hospital in Jerusalem. The
buildings she erected were low and plain, for it
was better, she said, to spend money on the poor
than on fine buildings. In the same letter to
Pammachius already mentioned Jerome gives a
lifelike picture of the homely duties of these
one-time luxurious Roman dames. ' And even
when you have done all the things I have
mentioned [he said] you are still surpassed by

Early Hospitals and Roman Matrons 141

your sister Eustochia as well as by Paula. . . .
I have heard that they were [in former days in
Rome] too dainty to walk the muddy streets,
that they were carried about in the arms of
eunuchs, that they disliked crossing uneven
ground, that they found a silk dress a burden and
felt sunshine too scorching. But now, squalid and
sombre in their dress, . . . they trim lamps,
light fires, sweep floors, clean vegetables, put
heads of cabbage in the pot to boil, lay tables,
hand cups, help to wash dishes, and run to and
fro to w^ait on others. ' They all worked as nurses
and servants in the hospitals. Mrs. Jameson
quotes from an old English translation of Paula's
life: 'She was marvellous debonair and piteous
to them that were sick, and comforted and served
them right humbly, and gave them largely to eat
such as they asked. . . . She was oft by
them that were sick, and she laid the pillows
aright and in point; and she rubbed their feet,
and boiled water to wash them; and it seemed to
her that the less she did to the sick, so much the
less service did she to God, and deserved the less
mercy. Therefore, she was to them piteous and
not to herself. ' ' l Like the other disciples of the
early Fathers, to whom care of the body was
incompatible with goodness, Paula shared the
ideas of the merit of physical neglect so inconceiv-
able to-day, and conscientiously reprimanded a
studied neatness in dress, which she called "an

1 Sisters of Charity, Mrs. Jameson, London, 1855, p. 18.

A History of Nursing

uncleanness of the mind. ' Jerome, who had re-
turned to Palestine with Paula, presided over a
monastery for men which she had built and
endowed. Thence he wrote to Marcella in 386,1
begging her to come to the Holy Land. She
did not respond, but Fabiola came instead,
a few years later, and the good old Father
was a little embarrassed as to how to lodge
a grand lady. A threatened invasion of the
Huns shortened her visit, and Paula never
saw her again. Jerome outlived all of
these famous Roman patrician nurses. In 399,
after Fabiola's death, he wrote her eulogy: "Was
there a monastery, ' he asked, 4 which was not
supported by Fabiola's wealth? Was there a
naked or bedridden person who was not clothed
in garments supplied by her? Was there ever
any one in want to whom she failed to give?'
When she died all Rome followed her to the
grave. " How great a marvel Fabiola had been
to Rome while she lived is shown in the behaviour
of the people since her death. ... I seem
to hear even now the sound of the feet of the
multitudes who thronged in thousands to attend
her funeral."2 And in 404, on Paula's death,
he wrote a long and eloquent letter of consolation
to Eustochia,3 in which he has left an inspiring
tribute to Paula's benignity and goodness.

1 Nicene and Post-Nicene Fathers, letter xlvi., p. 60.

2 Ibid., letter to Oceanus.

3 Op. cit., Letter cviii., pp. 195-212.

Harly Hospitals and Roman Matrons 143

These distinguished women had seen a profound
change come over the society in which they had
once been a part — an ancient empire tottering,
a new religion dawning. That form of community
life called monasticism, which Marcella's example
first established in Rome, was now about to
become the general form of organisation under
which men and women might find self-expression
outside of family ties.

CHAPTER III

THE RISE OF MONASTICISM

THERE have been four "Rules" recognised by
the Church for the government of monastic
orders — those of Basil, of Augustine, of Benedict,
and of Francis. These ' Rules, ' which for il-
lustrative purposes one might compare to un-
changeable constitutions, controlled the general
features and ordered the main development of
monastic nursing orders. To attempt an exposi-
tion of the profound spiritual, social, and economic
changes which lay at the root of monasticism,
more especially that of the West, which rapidly
took on an energetic social, industrial, and
intellectual character, would carry us far beyond
our bounds. So fascinating and important a
study, however, can readily be made by consulting
the special writers who have thrown light upon
it. We will only note, from the practical stand-
point, how all-important it was that the early
hospitals and institutions of brotherly love should
have had over them a strong protecting influence,
such as the Church rapidly became, to defend and

secure them from spoliation or violence. From

144

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The Rise of Monasticism 145

the time of Constantine on, the laws of the state
have had frequent reference to the organised care of
the sick and the destitute. According to the Coun-
cil of Chalcedony, in 451 A.D., the hospital was
the common adjunct of the church or sacred place.
In the reign of Justinian, 527-565 A.D., the bishops
were endowed with authority over the hospitals,
and this was a period of unexampled zeal and
activity in building shelters, hospices, foundling
asylums, and nosocomid, Uhlhorn points out l
that no more logical or sufficient reason for the
rise and rapid extension of religious orders and
their general guardianship of hospitals and chari-
table institutions could be asked for than the
necessity of protecting the revenues and property
bestowed upon such institutions from irresponsi-
ble or even lawless aggression. So, for protective
purposes, Gregory the Great, who enunciated the
subordination of the temporal to the spiritual
powers, expressly stipulated that 'religiosi'
ecclesiastics — only should be responsible for the
hospitals, not taking the direct management,
but placing competent heads in charge, because
they were secure from harassment by lay tribunals ;
and in 817 the Council of Aix declared the care of
the poor to be the chief duty of monastic com-
munities.2 It is therefore clear that a strong

1 Christian Charity in the Ancient Church, by Dr. Gerhard
Uhlhorn, Abbot of Loccum, Scribner's, New York, 1883, p.

337-^

2 Diet. Christian Antiquities, art., " Hospitals."

voL i. — 10

146 A History of Nursing

economic, as well as a religious impulse, underlay
the dominant monastic movement.

From the beginning of the fifth century, when
many important monasteries were founded, the
long and glorious record of the religious nursing
orders of men and women may be said to follow
a superb curve through a thousand years and
more, from its rise in the humble services of the
at first despised early Christians upward, through
the Middle Ages with their vast, wealthy, and
beautiful monasteries and hospitals and the
supremacy of monastic orders in every kind of
institutional activity and administration; and
downward again toward the present day, when,
modern times having brought a new science,
new economics, and new forms of social adjustment,
they no longer lead, and, in nursing are chiefly in-
teresting from the historical standpoint, though still
everywhere models of organisation and discipline.
But though forms change the spirit remains the
same, and to-day the men and wromen who would
once have been leaders and saints in churchly
orders may do, and are doing, the same work of
humanity as members of a civilian and secular
society.

It would be a great mistake to regard the early
monastic orders as offering a life of limited scope
to men and women. On the contrary the monas-
tery, or, as Lina Eckenstein graphically calls it,
the 'religious settlement' was for centuries the
only place where women at least could find

The Rise of Monasticism 147

freedom from social fetters or distasteful matri-
mony, and have liberty to conduct satisfying
work in their own way, with opportunity to
develop and cultivate intellectual tastes. The
early Benedictine monasteries have been likened
to small republics, where each member, proud
of his community, brought his best to give to it.
"The monasteries were the birthplaces of free
labour," says Uhlhorn. The Benedictines have
been called the "depositaries of learning and the
arts,"1 and the monastery was a community
complete in itself, with its own gardens, mills,
industries, farm, library, and workshops. Bene-
dict founded Monte Cassino in 529 A.D., and he
planned, beside religious exercises, seven hours a
day for manual work and two for reading. The
members of the community elected their head,
and, though strict obedience was the rule, yet on
the other hand the rule of Benedict was a sort
of constitution preserving certain bounds to the
abbots' or abbesses' powers, and these officers
were always required to consult in serious ques-
tions with the members of the convent. The
freedom and likewise the importance of women
in early monastic! sm have long been ignored.
Of recent years most interesting studies have
been made on this subject, the most enlightening
of which are the work of women. As the monks,
though now ranked as regular clergy, were up

1 " Benedict and the Benedictines," Amer. Journ. Educa-
tion, xxiv., p. 525.

A History of Nursing

to the time of Boniface IV. a lay body, so in
the earliest centuries the monasteries for women,1
and especially those of the Benedictines, were
not bound by enclosure, nor was the monastic
dress compulsory. In 1190 a protest was written
by a Bavarian monk, who found it objectionable
that the professed religious women of the district
should go about as freely as monks and without
a distinctive dress. He would fain have curtailed
their liberty, but as this was not possible he
thought that they should at least wear a dis-
tinctive dress so that they would be recognised.
At the close of the tenth century the dress of nuns
was not different from that of the laity.2 Ab-
besses and nuns of royal birth wore gorgeous
raiment for occasions of state, and the abbesses
of the seventh, eighth, and subsequent centuries
held commanding positions. They attended ec-
clesiastical synods and attested their decrees,3

1 Gasquet says: "It is altogether wrong to apply the word
'convent' exclusively to houses of nuns. . . . The title
'convent' as well as that of 'monastery' and 'abbey' was
applicable to any house of either monks or nuns, and the
exclusive use of the word 'convent' for a religious house
of women is of quite modern origin." English Monastic Life, by
Abbot Gasquet. Methuen Co., London, 1905, p. 154.

2 Tuker and Malleson, op. cit., iii., p. 37.

3 While the abbesses were rising to their zenith the church-
men were not inactive. The Council of Aix-la-Chapelle in
816 decreed that the abbesses should not give the veil or
usurp bishops' functions, and the council of Paris forbade
them giving the communion. Ludlow, p. 113 in Woman's
Work in the Church, London, 1865.

Ancient Costume of an Abbess
Diet., des Ordres Religieiises, Migne, xxi., fig. 290

The Rise of Monasticism 149

while in England four abbesses were summoned
to Parliament as peers.1 Saxon abbesses had
the duties and the privileges of barons, and
as such were summoned to the Imperial Diet,2
though it is not certain that they went in person.
More startling yet in their difference from any-
thing in modern times were the great double
monasteries, where the abbess ruled over related
houses of monks and of nuns. These arose al-
most simultaneously with monasticism.3 Anglo-
Saxon nunneries were almost all instituted on
this principle.4 Famous abbesses who ruled thus
over both women and men were Radegunde at
Poitiers; Hilda at Whit by in England, who had as
her scholars some of the great bishops, and who
taught Caedmon, the first English poet; and Her-
sende at Fontevrault, who ruled a vast estab-
lishment of, in all, some three thousand souls.
The Benedictine settlement of Fontevrault,
now extinct, was founded at the end of the
eleventh century by Robert Arbrissel, whose
decree it was that the women should rule. For
six hundred years it stood, 'a unique instance of
uniformly remarkable government and adminis-
trative ability." It was ruled by a line of thirty-
two abbesses, whom a French writer has spoken of

1 Tuker and Malleson, op. cit., iii., p. 58. This lapsed on
account of sex, says Eckenstein, 203.

2 Eckenstein, op. cit., p. 152.

3 Tuker and Malleson, op. cit., iii., p. 29.

4 Ibid, iii., p. 30.

150 A History of Nursing

as "a succession of eminent men.' Not without
constant vigilance did they maintain their suprem-
acy: " each rule and privilege in turn attacked was
defended and maintained.' The abbesses ad-
ministered the property of the community,
maintained discipline, and each monk, as well
as the nuns, swore obedience to her. " Every-
where feminine supremacy, ' and no religious
community was more prosperous and eminent.1

In discussing the notable eminence of these
communities under the rule of women, Tuker and
Malleson note that the opposite system, that of
the rule of women's orders by an abbot, met
everywhere with failure, and that such groups did
not flourish or survive.2 In their opinion it is a
fact capable of daily proof that a woman is a more
successful leader of men and women than a man;
and they add: " In the present day the government
of female orders by male orders has been found an
obstacle to the due development of the former, and
relief from it is frequently sought of and granted
by the Holy See. ' Eckenstein writes: " Houses
ruled by women became important centres of cul-
ture and art. A sense of joint ownership united
the members of the religious settlements."

The fact that the monasteries were not special-
ised each for one narrow line of work must have
been their greatest charm. As the xenodochium

1 See Tuker and Malleson, op. cit., iii., p. 119.

2 Ibid. iii.. p. 31.

3 Ibid, iii., p. 31.

The Rise of Monasticism 151

included every department of relief, so the monas-
tery embraced every form of occupation . Ecken-
stein points out the ' manifold and distinct
spheres of activity which life offered inside the
religious community — the studious, the educa-
tional, the philanthropic, and the agricultural
elements — all to some extent made part. . . .
Tastes which were widely dissimilar, and tempera-
ments that wrere markedly diverse, met with
encouragement in the religious settlement. The
scholar, the artist, the recluse, the farmer, each
found a career open to him, while men and women
were prompted to undertake duties within and
without the religious settlement which made
their activity comparable to that of the relieving
officer, the poor-law guardian, and the district
nurse of a later age."1 The monasteries were
centres of learning, and in this the nuns were distin-
guished. The copying of precious manuscripts was
their work also as well as the men's. Cesaria ju-
nior's letters to Radegunde, imparting the rule
of her house, has been called one of the ablest
literary monuments of the age,2 and ' ' Radegunde
herself was a still more remarkable nun,' her
spirit richly stored with knowledge. The Benedic-
tine nuns both taught and preached, and the
evangelisation of Europe was largely their work.3
The learned Hrotswitha, at Gandersheim, then

1 Eckenstein, op. cit.. pp. 185-186.

2 Tuker and Malleson, op. cit., iii., p. 25.

3 Ibid., iii., p. 80.

i52 A History of Nursing

the principal seat of civilisation, arts, and piety
in Northern Europe, was well versed in Latin
classics and wrote dramas of great literary
ability. A French writer calls her the Christian
Sappho and a glory to the whole of Europe; yet
she lived in the tenth century, the darkest period
of the middle ages. In the sixth century Bertile
of Chelles drew large audiences of men and women
to her lectures on the Scriptures,1 and in the
eighth century Lisba, Walburga and Berth -
gytha, Anglo-Saxon nuns who evangelised Ger-
many, "were profoundly versed in the liberal
sciences. '

The liberal sciences included medicine and
nursing, which these able women studied with
unselfish purpose, for we are told of Walburga:
' She was a strong-minded and learned woman,
and, like many, she studied medicine to minister
to the poor. ' Connected with each monastery
were the oblates or associate members, who might
be of any age, quality, or rank. Either in life
within the monastery walls, or living in their own
way elsewhere, these men and women gave their
services to the many undertakings of the com-
munity and shared in the interests of all, much as,
to-day, non-resident members of a social settle-
ment share in its activities without completely

1 Tuker and Malleson., op. cit., iii. p. 81.

2 Ibid., p. 80.

3 Legends of the Monastic Orders, by Mrs. Jameson, Long-
mans, London, 1850, p. 85.

The Rise of Monasticism 153

identifying themselves with it or giving up their
ordinary life.

Not only did the monks and nuns practise
medicine, but for long periods of time they seem
to have been the only practitioners. Haeser says :
' No proof is needed that they studied medicine.
Though some did not go beyond folk-lore, others,
as Masona of Merida, became eminent, and about
the thirteenth century a higher medical knowledge
among the clergy was quite widespread. Monks
were sent from their cloisters to study medicine
in Paris. ' In general, medical historians agree
that the medical practice of the Middle Ages was
almost entirely confined to the members of the
monastic orders. It would be a mistake, however,
to regard this medical knowledge as free from
superstition, but often quite the contrary, for
no superstitions in the world have been so persis-
tent as those relating to health and sickness. The
teachings of some of the early Fathers had been in
sad contrast to the enlightenment of Basil: thus
Origen had believed that the archangel Raphael
had especial care over the sick and infirm, and
that pestilence, sickness, and other bodily afflic-
tions arose from diabolical emanations of the
principle of evil. Cyprian had also charged the
demons with causing luxations and fractures.1
Charlemagne did much to elevate the study of

1 History of Medical Economy during the Middle Ages,
by Geo. F. Fort, M.D , 1883. Chap, iv., pp. 66-70.

154 A History of Nursing

medicine, and while his influence lasted it held an
honourable position. But the study of medicine
was not pursued throughout the Middle Ages by
the religious orders without opposition from the
Holy See, for many repressive decrees are recorded.
The Lateran Council in 1123 A.D. forbade the
practice of medicine to monks and priests. In
1131 the Council of Rheims prohibited monks
from frequenting medical schools and limited
their practice to their own monasteries. In 1139
a Lateran Council decreed severe penalties for
monks and priests who practised medicine. In
1163 Pope Alexander III. issued a prohibition,
and in 1215 Innocent III. issued an anathema
against the practice of surgery.1

The highest degree of practical medical skill
with understanding was found among the Bene-
dictines, who, excelling in all pursuits requiring
intellectual labour with practical application, ex-
ercised a more specially intelligent interest in
matters relating to medical and surgical relief.
Benedict in his Rule had said, ' Before all things
and above all things care must be taken of the
sick"; and Cassiodorus, once the chancellor of
Theodoric, who in his old age became a monk,
recommended the brothers to read the works of
Hippocrates, if possible, in the original.2

1 A Chronology of Medicine, John Morgan Richards,
Balliere, Tindall, Cox, London, 1880, pp. 81-82.

2 For an interesting sketch of Cassiodorus see Gissing's
By the Ionian Sea.

The Rise of Monasticism 155

Beside the infirmarium, or ward within the
cloister for the reception of members of the order,
there was also usually, at least in important
communities, the outer, detached hospice for
strangers and patients in general. Both of
these are believed to have existed at Monte
Cassino. The monastery of St. Gall, built in 830
A.D., possesses a plan of its infirmary, — probably,
says Withington, who reproduces it, the most
ancient plan of an infirmary in existence. The
infirmary was presided over by an Infirmarius ;
the hospice by a Hospitalarius. Benedict
himself died of a fever contracted while caring
for the poor near Monte Cassino.1

It was the custom, writes Helyot, for the monks
and nuns of related orders to serve the hospitals
conjointly. The monks did the nursing in the
men's wards and the nuns in the women's.
Toward the middle of the thirteenth century
this arrangement was common all over Western
Europe; or, where the nuns were in charge of an
entire hospital, the monks of the same order
acted as priests.

The glimpses which one may get of the nursing
methods of those days show quaint pictures of
good practical procedures. Lipinska, quoting an
old writer, thus describes the management of a
patient: They covered her warmly, put wrarm
bricks on her abdomen, rubbed her feet with

1 Legends of the Monastic Orders, by Mrs. Jameson, ed. of
1901, p. 43.

156 A History of Nursing

vinegar and salt, cooled her head with rose-water,
and when she perspired covered her with a quilt.
Then she had a rice-water broth to which milk of
almonds was added, then sugar of violets to
assist digestion and a pomme de grenade to freshen
her mouth. ' And Eckenstein quotes from
similar sources:

Often change their beds and clothes, give them
medicines, lay to them plaisters, and minister to them
meat and drink, fire and water, and all other neces-
saries night and day, as need requires after the counsel
of the physicians, and precept of the sovereign; do
not be sqeamish in washing and wiping them by
avoiding them; be not angry nor hasty, nor im-
patient though one have the vomit, another the flux,
another the frenzy, and now sings, now cries, now
laughs, now weeps, now chides, now is frightened,
now is wroth, now well apayde, for there be some
sickness vexing the sick so greatly and provoking
them to ire that the matter drawn up to the brain
alienates the mind. And therefore those in atten-
dance should have much patience with them, that
thereby they may secure an everlasting crown.2

Abelard's instructions for the convent over which
Heloise presided in the twelfth century included
the following references to nursing and medicine:

Let the infirmaria look after the sick . . . ; whatever
their infirmity requires, whether in food, baths, or

1 La ^Medicine et les Religieuses du Moyen Age, "by Melanie
Lipinska, M.D., in La France Medicate, Juillet 25, 1900,
p. 262, in footnote.

2 Eckenstein, op. cit., pp. 393-394.

The Rise of Monasticism 157

anything else, is to be given them. . . . There
must always be some one on duty to give aid when
required, and the place must be provided with all
things necessary in sickness. Drugs must also be
got if necessary, and this will be done more easily
if the presiding Sister is not without medical know-
ledge. It is she also who must look after those who
are bled, and some sister should be skilful in vene-
section, that it may not be required for a rnan to
come in for this purpose.

It is not, however, believed that the nuns under
Heloise practised nursing except in their own
private infirmary, as their rule was a strict one
and kept them secluded.

In the earlier centuries the names of individuals,
sometimes of royal and sometimes of humble
origin, are prominent in the records of hospital
nursing service, and besides the more systema-
tised work of the religious orders the custom of
volunteer visiting nursing in hospitals, as practised
in apostolic times — or, if we recall the charitable
kings of India, of even more remote origin- -was
considered useful and praiseworthy. One of the
earliest instances of this kind is that recorded of
the Empress Flaccilla, the wife of Theodosius
the Great, who went daily to the hospitals con-
nected with the churches, where, we are told, she
washed and dressed the sick, made their beds,
prepared food for them, and fed them herself,
and performed every duty of a faithful nurse and
servant. Some writers have even said (though

158 A History of Nursing

we hold this statement doubtful) that she scrubbed
the floors. When remonstrated with for doing
this menial work she made reply that, while
the Emperor might give his gold, she would give
her services. Similar service is given to-day in
the Italian hospitals, where, in affiliation with the
Third Order of St. Francis, volunteers from all
ranks of life, nobles and princes as well as plain
citizens, still take their turns in going to the
hospitals, where they bathe and dress patients,
cut their hair and nails, and perform all kinds of
practical duties.

An important early community, in which much
attention was given to the care of the sick and in-
firm, was that at Aries, founded in 542 A.D., where
Cesaria and her brother Cesarius presided re-
spectively over monasteries for women and men.
Cesarius, a saintly man, had been placed in charge
of the monastery, which had not, as it appears,
been of much importance before his day. He
devoted himself with great ability and energy to
enlarging and adding to it. His first care was to
build a large hospice, where the poor might
receive every care that their condition demanded,
and to create a monastery for women, where his
sister Cesaria took charge of two hundred nuns.
Cesarius drew up the rule for them, the first one,
probably, drawn up for a Western community of
women.1 A strict communism was practised here.
The members renounced private property, and no

1 Biog. l^nivi-rsellt'. Michaud, art. " C^saire."

The Rise of Monasticism 159

servants were kept. The nuns practised music,
sang in choir, studied reading and writing,
copied manuscripts, performed all the domestic
duties of cooking and cleaning, weaving and
spinning, and tended the sick in the hospice. The
life does not appear to have been unduly restricted.
Members were not permitted to take permanent
vows before the fortieth year, and women from
other religious houses might be received and
entertained.

A prominent figure in early nursing was Rade-
gunde, a friend of Cesaria junior, and one of the
first women known to have ruled supreme over
a French convent,1 for the community of Aries
had been under the final authority of Cesarius.
Radegunde, from every point of view a notable
and heroic figure, the daughter of a Thuringian
king and a descendant of Theodoric, is described
as a woman of forceful character and brilliant
intellect. Her marriage with King Clothacar
was compulsory and unhappy. True, it is re-
corded that she neglected her duties as a wife and
queen, keeping the king waiting for his meals
while she conversed with learned men who came
to the court, but as he had seven wives, of whom
she came fifth in order, these duties could not have
been very sacred. He was made of coarse clay,
'a cruel and licentious prince,"2 and she was

1 Eckenstein, op. cit., p. 51.

Julia Kavanagh, Women of Christianity, D. Appleton
Co., New York, 1852, p. 59,

i6o A History of Nursing

vastly his superior in mind and capacities. She
finally left him and fled to Noyon, pursued by
her husband's vassals even into the church, where
she took refuge. She demanded to be received
under the protection of the Church, and Medardus
consecrated her a deaconess. She then visited
the convent of Aries to see the arrangement of
life and occupation. On her estate near Poitiers
she founded a great settlement, where the house
of nuns numbered about two hundred. She had
ahvays been deeply interested in nursing, and even
while in her husband's palace it had been her con-
solation to give her apartments for the use of the
sick poor, whom she loved to serve with her own
hands. There she had taken in the lepers,
washed them and waited on them and made them
at home.1 (No doubt this must have been a
constant source of irritation to her husband.)
Now in her convent of St. Croix she built " gardens,
baths, porticoes, galleries, and a church. ' The
baths are especially noticeable, for with the fall
of the Roman Empire they had almost disappeared
from mediaeval life. Radegunde's biographer,
Fortunatus, says Eckenstein, describes her nursing,
how she 'shrank from no disease not even
leprosy. ' Beside the care of the sick, her com-
munity "read the Scriptures" and studied ancient
literature, transcribed manuscripts, and worked
at dramatic performances, the germ of the Mystery
plays of the Middle Ages. Radegunde, as a

> Kavanagh, op. cit., p. 59.

The Rise of Monasticism 161

royal princess, kept up her interest in public
affairs. She was a lover of peace, and often
intervened as a peacemaker in the quarrels of
rulers. She lived in her convent as a simple
member, having placed another nun, Agnes, in
charge as abbess ; but, although she devoted
herself incessantly to the most laborious duties,
the whole community regarded her as the head
and centre, and her death, in 587, was bitterly
mourned.1

Another famous convent was that of Hohenburg,
in Alsace, where a long succession of intellectual,
literary, and charitable abbesses ruled and ex-
tended hospitality to all comers, the sick and the
well. Here Odilia, the first abbess, whose sway
extended through the early part of the eighth
century, built a ho spit-urn half-way down the
hill to accommodate travellers and patients;
and more than three centuries later the celebrated
Herrade, who was abbess in 1167, and who wrote
a work in Latin called the Garden of Delight,
in which she collected in brief all the history and
scientific knowledge of the day, built, in 1181,
a second and larger hospice at the foot of
the hill.2 At the magnificent double monas-
tery of Fontevrault, already spoken of, there
must have been an extensive nursing service,

' The Monks of the West, from St. Benedict to St. Bernard,
by Montalembert, John C. Nimmo, London, 1896, vol. ii., pp.
167-179.

2 Wetzer und Welte's Kirchenlexikon, art., "Hohenburg."

VOL. I. II.

1 62 A History of Nursing

for neither the lepers nor the helpless were
refused.1

This vast community, where women held
supreme sway, also made the reformation of
fallen women an object of special care. From
the earliest days the care of the lepers had been
the chief thought of tender-hearted persons.
Nor did the Christians alone feel this sympathy,
for in the third century there is record of a Jewish
rabbi who devoted his life to these unfortunates,
living with them and teaching their children.

Most remarkable of all the women of the early
centuries whose records have been preserved
was Hildegarde,2 called the 'Prophetess,' the
' Sibyl of the Rhine, ' whose chief importance
from a less credulous modern standpoint is her
unique position as a teacher of medicine. Born
in 1098, at Bockelheim castle, near Kreuznach, of
noble family, Hildegarde was. a delicate child of
extraordinary mental qualities. In her eighth
year she was brought by her parents to the convent
Disibodenberg (so called because the holy Disi-
bodus from Ireland had made his abiding-place
there after he had wandered to Germany on his

1 Eckenstein, op. cit., p. 194.

2 The chief work consulted is Das Leben und Wirken
der heiligen Hildegardis, by J. Ph. Schmelzeis. Herder, Fri-
bourg, 1870.

Schmelzeis bases his work mainly on the biographies written
by the monks Theodoric and Gottfried after Hildegarde's own
story of her life and preserved in the Ada Sanct. Boll Sep-
tember 17.

The Rise of Monasticism 163

mission to convert the heathen) , to be reared by
Yutta, a pious dame of birth. After Yutta's
death Hildegarde, at the age of thirty, became
the head of the convent, a double one under the
rule of an abbot. Her mental force and distinc-
tion gave her a natural supremacy over all who
came in contact with her, and so unusual was her
intellectual acumen and so lofty her soul that she
was early regarded as a prophetess. She herself
accounted for very extraordinary intellectual
powers by ascribing them to a kind of revelation
which was vouchsafed to her frequently, in some
mystic or clear-seeing state, not in the least akin
to trance or ecstasy, for of the latter there is no
record whatever in her biographies. After ten
or eleven years spent in the double monastery,
Hildegarde severed herself from it, and moved to
Rupert sberg, where, as the abbess of her own
community, she was absolutely independent, and
where she gathered about her a large group of
women of noble family, As this community grew
she founded the convent of Eibingen as a branch
house, During her long life of eighty-one years
Hildegarde became possessed of an amount and
kind of knowledge which may well have seemed
miraculous and was, in fact, so explained. This
knowledge embraced medical science, nursing,
natural science, or nature-study, with a spiritual
and religious philosophy of majestic proportions.
Added to this, her acquaintance with the minutest
details of the political life of the age, the ten-

164 A History of Nursing

dencies of dynasties, and the ambitions of princes
and potentates was searching and exact, so that
she was competent to point out danger, to warn,
menace, and foretell with unerring judgment
what would happen. She foretold the downfall
of the German Empire, the disasters of the
papacy, and the approach of the Reformation,
and did not fear to speak in terms of dominance
to Frederick Barbarossa himself. It is little
wonder that, uniting such intellectual qualities
with an equally noble and commanding charac-
ter and merciful, tender nature, Hildegarde should
have been revered, beloved, and looked up to
as an inspired being, not only by the many
invalids who came to her for cure and the stream
of pilgrims who came for counsel and ad vice , but
also by the great ones of the world- -prelates,
kings, and princes — with whom she had such a
remarkable correspondence. Hildegarde's letters
are the monument to her social pre-eminence; her
books, of which there are a large number, testify
to her learning and originality of thought. She
was also musical, and has left a number of hymns
set to musical forms of her own composition.

But Hildegarde's greatest claim to the admira-
tion of a modern and non-transcendental age is her
knowledge of medicine. She is more conspicuous
as a physician than as a nurse, though she com-
bined the arts of both. Modern physicians have
not failed to study the scientific attainments of
Hildegarde with frank attention and serious in-

The Rise of Monasticism 165

terest. She wrote two medical books: one, the
Liber Simplicis Medicines, called also the
Pkysica, and which she herself spoke of as
the "liber subtilitatum de diversis creaturis, '
and the other the Liber Composites Medicines,
dealing with the causes, symptoms, and cure of
disease. Herein is ' much regarding the nature
of man, of the elements, and of the different
created orders and of how to be useful to these. '
" In these two books of medicine Hildegarde
traces and expounds the mysterious meanings of
the marvels and the secrets of nature in such a
way that a woman could not possibly know
such things except through the Holy Spirit. ' So
write the ancient commentators, one of whom
calls the book of simple medicine ' good ' and
"very wonderful"; the other 'a distinguished
work.' Reuss, a critic of later times, wrote;
" Much was known to her that the other writers
of the Middle Ages were ignorant of and that
keen-eyed investigators of our time have found
out and brought to light as new discoveries. '
Another work of Hildegarde, Liber Operum
Simplicis Hominis deals with anatomical and
physiological subjects. Melanie Lipinska, a bril-
liant woman physician of the present time,
writing of Hildegarde 1 places her first among all
the monastic women who practised medicine in the
Middle Ages, and also emphasises her superiority
in knowledge over all of her contemporaries.

1 Op. cit., pp. 261-266.

1 66 A History of Nursing

She points out that Hildegarde foretold auto-
infection, and almost seemed to foretell or to
comprehend the circulation of the blood; that
she regarded air as a food; that she recognised
the brain as the regulator of all the vital pro-
cesses and as the centre of life, and understood
the influence of the nervous system and marrow
on the process of development. ' In short, a
profound intellect, reflecting on all subjects with
the intuition of genius, full of experience, em-
bracing the whole science of her time : so does she
appear in her first medical work. '

The 'liber subtilitatum ' is, says Dr. Reuss,1

'the most valuable record of German natural
science and medical knowledge in the Middle
Ages, scientifically considered.' He considers
that many of the ideas of natural philosophy,
observations in zoology and botany, and pharma-
cological discoveries of modern times are detailed
or suggested in the "liber subtilitatum.' Reuss,
himself half scientific and half mystical, calls it
" a German national work, — a codex of German
natural and medical science, of German cloister
and folk medicine. . . of highest value. . . .
No less precious is it as a history of morals,
mythology, and economics. " He explains her
intellectual achievements as having been possible

1 not by means of the senses nor yet in somnam-
bulistic ecstasy, but through inner illumination
of the understanding and divine revelation. . . .

1 Quoted by Schmelzeis, p. 500.

The Rise of Monasticism 167

Thus only,' he says, 'is the keen vision of
the saint explicable, which, towering far above
the scientific standpoint of that day, enabled
her to penetrate the innermost secrets of nature
and to frame such a deeply reflective, mystic,
speculative, and comparative explanation of the
life of the plant and animal world. ' The modern
mind, however, would hardly conjecture that
Hildegarde's knowledge was not based on the
evidence of the senses. But how did she gain
this knowledge? It is supposed (from incidental
and extremely brief references in her writings)
that the care of the sick was a feature of the
convent life both at Disibodenberg and on the
Rupertsberg, and it is most probable that this
is true, as such duties were common to all mon-
asteries. No account of nursing work as such,
however, and no special mention of the care of
the sick are to be found in her biographies (founded
on her autobiography) save here and there
passing allusions to wonderful cures, and to the
numbers of infirm who came to her for advice and
treatment. Nor does Schmelzeis give attention in
his ample volume to nursing as such.1 Lipinska,
quoting Reuss, merely says : ' She had in so high
a degree the art of curing that no ill person came
to her who did not recover health.' Wherever

1 Inthelnternat. Encyc. (art., "Xursing") the statement is
made that Hildegarde founded a " training school for
nurses " for service in the hospitals, but this would appear
to be too modern an idea to be accepted literally.

1 68 A History of Nursing

there are legends of miraculous cures there has
always been some distinguished success in practi-
cal treatment, some individual gifted with know-
ledge of medicine and nursing. Hence it may be
reasonably concluded that Hildegarde gained her
medical knowledge not transcendentally, but
from the observation and management of patients ;
and it would seem highly probable that she had
detached herself from Disibodenberg and the rule
of the abbot for the purpose of having complete
liberty of intellect and of time to devote herself
to research. She has recorded the widespread
and persistent opposition that she encountered
in taking this step, and the malicious whispers
that went about. ' How is it that so many
secret things are revealed to this silly and untaught
woman, when there are plenty of wise and zealous
men?' "Many,' added Hildegarde, 'wondered
whether my revelations came from God, or were
seductions of evil shades. ' Besides popular mut-
terings there was much opposition from the
monks, who wished to keep so distinguished a
member to reflect glory on their own otherwise
insignificant community, and from the church
dignitaries, but all finally yielded before her
reiterated declaration that she was inspired by
the divine will. Schmelzeis, who accepts unre-
servedly the theory of supernatural guidance,
relates with great minuteness the care and per-
sistency with which she freed herself entirely
from the control of the abbot of Disibodenberg,

The Rise of Monasticism 169

and carefully explains and justifies her whole
attitude in this bold emancipatory action, on the
ground of the great purposes divinely held in
store for her, as proved by her subsequent career
of eminence as a moral teacher, adviser, and
oracle.

Hildegarde's medical works were written be-
tween 1151 and 1159, when she was nearly sixty
years old. In a recent publication a German
physician has examined them with considerable
minuteness of detail, 1 translating and transcribing
from them copiously. The list of subjects which
she deals with is indeed amazing, and includes
the whole range of sexual physiology as well as
of medicine and hygiene. Perhaps it was because
of the startlingly scientific character of her medical
books that they were not included in the list of
writings made under the auspices of the Church,
and this may, too, have been the reason why
Hildegarde, though revered and celebrated as a
saint, was never officially canonised. She is,
however, enrolled as a saint2 in the Martyr ologium
Romanum. Hildegarde's religious writings are
equally remarkable, but with these, and her
journeys, on which she publicly preached and
taught, our subject does not permit us to concern
ourselves. It is to be hoped that some day there

1 Dr. phil. Paul Kaiser, Die Schrtft.der Aebtissin Hildegard
in Therapeut. Monatshefte, Berlin, June-Dec., 1902.

2 All gemeine Deutsche Biographie, art., "Hildegard." von den
Linde. Leipzig, 1880.

170 A History of Nursing

may appear, what v. d. Linde says has not yet
been written, a scientific or rational life of
Hildegarde. !

i Allgem. Deutsche Biog., art., " Hildegard."

CHAPTER IV

THE MILITARY NURSING ORDERS

ANY history of the Orders of Military Hospi-
tallers, which for seven centuries held the
attention of the civilised world and even now
rise before us in splendid and soul-stirring recol-
lection, of necessity must include some account
of the Crusades which gave them birth. The
"supreme folly of the Middle Ages,' some
writer has called the Crusades, and the phrase has
passed into common use. ' For myself, ' says
Froude, " I no more call the Crusades folly than
I call the eruption of a volcano folly, or the French
Revolution, or any other bursting up of the lava
which lies in nature or the heart of mankind.'
In all climes, in all ages men have looked upon
certain places as sacred, either because of events
which have taken place upon the spot or because
relics have been there enshrined; and whatever
the object, whether to obtain relief of mind,
body, or soul, the long record of visits and pil-
grimages to temples, sepulchres, and other holy
places, stretches back and is lost in the dim
vistas of the past. The temples of Greece and

171

A History of Nursing

of Mecca, the sacred places of the devout Buddhist,
the tombs of kings, saints, and martyrs, have all
been the scenes of pilgrimages made by the faithful
or suffering souls of their day, and it is easy to see
how dear and sacred all Christians would hold
the cave hollowed out of the rock near the place
where Christ was crucified, and wrhere His body
was afterwards laid. Soon after His ascension,
we are told,1 pilgrimages to Jerusalem began.
With scrip and staff the pilgrim fared forth on his
long and painful journey, returning if all went
well to place a branch of the sacred palm tree over
the altar of his church in proof that he had ful-
filled his vow. Women undertook these jour-
neys as well as men. Helena, the mother of the
Emperor Constantine and the first woman to go
to Palestine, won the admiration of early writers
for the "remarkable courage and warm devo-
tion' with which she made the pilgrimage and
built her church at Jerusalem. Paula followed her,
and the result of her pilgrimage was the series
of hospitals built by her that " no one need suffer
for lack of shelter on the road where Mary the
mother of Christ had no refuge but a stable. '
The tide of pilgrims finally became so great that,
as one writer says, the journey became what
might be termed a fashionable recreation, so that
as early as the fourth century certain bishops
lifted up their voices against the growing fashion,

1 Tlte History of the Crusades, by Charles Mills, Longmans,
London, 1828, vol. i., p. 3.

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The Military Nursing Orders 1 73

and warned the women more especially of its
perils. The love of pilgrimages, Mills tells us,
was nourished by a circumstance having no
apparent connection with a spirit of devotion.
The constant intercourse which France had for
many years maintained with Greece then extended
to the opposite shores of the Mediterranean, and
commerce and religion so joined hands that the
" holy traveller and worldly merchant were often
united in the same person, and the hospitals which
charity had founded for the faltering pilgrim on
the road to Jerusalem were the resting places of
the caravans."1 There appears to have been a
further incentive to the making of pilgrimages in
large profits to be obtained from the sale of relics
credited with miraculous properties; particularly
those fragments of holy wood said to be portions
of the true cross, concerning which Erasmus was
prompted to say, " If the fragments of the cross
were collected enough would be found for the
building of a ship. ' Meanwhile the holy city of
Jerusalem became the scene of increasing con-
tention and warfare. At first the conquering
pagans built temples to Venus and Jove over the
most sacred places. In the fourth century the
Cross triumphed and Christian churches replaced
the heathen temples. In the seventh century
arose the Star of Islam, and the mighty Mahomet
held sway until the invasion of the Turks from
the North ended in making these fierce barbarians

1 Mills: The History of the Crusades, vol. i., p. 12.

174 A History of Nursing

the masters of Palestine. Throughout the earlier
centuries the places so venerated by Christians
had been open to pilgrims of every land, from
India to Britannia, and few restrictions were
placed upon their visits beyond the exaction of
various fees and taxes. As the sword of Mahomet
took the place of eloquence as a means of propa-
gating his religion, the difficulties of the pilgrims
grew into dangers. Safety had to be purchased
by tribute money, and violence added to robbery
threatened them on all sides. But neither dif-
ficulties nor dangers stayed their progress, and
pilgrimages went on increasing until the prevailing
belief that the world would come to an end in
the year 1000 carried a wave of religious fervour
over Europe and sent Christians in thousands
crowding to the Holy Land. The roads were
covered with multitudes of either sex and of every
rank, who professed their contempt of life so soon
as they should have kissed the tomb of their
Redeemer. ' ' l Their ill-treatment at the hands
of the infidels, the miseries and indignities which
they suffered, at length (about 1050 A.D.) led
certain rich merchants of Amalfi to establish at
Jerusalem two hospitals (one for each sex) under
the protection of St. John the Almoner2 and St.
Mary Magdalene. Here, says Mills, the "weary

1 Gibbon's Roman Empire, vol. vii., p. 175.

2 Neither the Evangelist nor the Baptist, but a certain
Cypriot, surnamed the Charitable. Hallam's Middle Ages
vol. i., p. 54.

The Military Nursing Orders 175

palmers found repose, the sick were healed and
the poor relieved. . . . Humanity was para-
mount over distinction of sects; and even no
unfortunate Mussulman ever supplicated at the
gate in vain."1 The generous and tender minis-
trations of the attendants aroused a widespread
interest, and we are told that alms and gifts were
sent from all quarters to defray their expenses,
while fresh service was constantly offered by
pious pilgrims who, instead of returning to their
homes, stayed to devote themselves to the
wanderers constantly arriving, sick or destitute,
from the West. Those whom robbers had
plundered were reclothed ; those whom disease had
debilitated were tended with skill and tenderness ;
and those who died were buried with Christian
rites. This hospital of the Almoner was the
cradle of the illustrious fraternity the Knights
Hospitallers of St. John of Jerusalem, of Rhodes,
and of Malta, who for seven centuries continued
to be the sword and buckler of Christendom in
Paynim war,"2 and whose achievements 'shed
a long tract of splendour through time. '

The Christians under the caliphs had undergone

1 Mills, History of the Crusades, vol., i., p. 14.

2 Knights of Malta, Sutherland, p. 23.

3 Hospitallaria, p. 37. There must have been some earlier
establishment, for Vertot speaks of Bernard, a French monk,
who in 870 A.D. made a pilgrimage to Jerusalem, and found
there "an hospital for the Latins, and in the same house a
library collected by the care and at the expense of Charle-
magne."

1 76 A History of Nursing

much suffering and misery, but under the sav-
age Turcomans these increased a thousand-fold.
Weary pilgrims, unable to pay tribute, " perished
at the very gates without the solace of having
seen the hallowed crypt which they had journeyed
so far to behold."1 Those who survived the
oppressions and cruelties of the Turks returned
home "ill, weary, and pennyless,"2 bringing tales
of their own sufferings and of the sacrilege inflicted
upon the Holy City; and the story of their woes
gradually aroused in the Western nations a
feeling which found vent later in the Crusade.3
" In the course of a few years was kindled a flame
throughout Europe which oceans of blood spilled
through several centuries of ferocious warfare
could scarcely extinguish. At the name of Pales-
tine every Christian warrior grasped his lance,
and the idea of rescuing the Holy City from the
infidel dogs, and of avenging the sufferings of the
Christians, aroused at last a storm of feeling which
grew into a whirlwind of increasing and uncon-
trollable action." The Cross bore all before it and
its champions grew into a mighty army. Guided
by Peter the Hermit they swept on, one hundred
thousand fighting men, and six hundred thousand
pilgrims able to bear arms, besides priests, monks,
women, and children. The disorderly, undisci-
plined mob, called by Mills an ' infernal multi-

1 Knights of Malta, Sutherland, p. 24.

2 Mills, History of the Crusades, vol. i., p. 17.

3 Knights of Alalta, Sutherland, p. 24.

The Military Nursing Orders 177

tude, ' perished miserably at the hands of the
infidels before they had rescued a single city.

Their "graver and nobler brethren' who
followed them under Godfrey de Bouillon wjsre
those who made the name of Crusader famous.
" A more glorious army the sun never beheld. Its
admirable order was the wonder of all beholders.
Every movement was by sound of trumpet, the
least disorder in discipline punished severely — a
regular school for all the details of a soldier's day.
. . . Brave, patient, sober, charitable as ever
they could be, were those gallant warrior
heroes,1 whose like the world never saw.'
" Their camp presented the rare and edifying
spectacle of a chaste and sober soldiery; and,
although not free from the common disposition
of extolling past ages at the expense of the present,
the confession was drawn from the severest
censors that there was far more virtue among
the crusading warriors than among the hosts
of Israel in olden time. The simplicity and
purity of the early Church were revived. So
affectionate was the union between the brother-
hood that all things were held in common.
The generals not only commanded and fought,
but watched, and performed the most humble
duties of the camp ; so that the officer and soldier
were scarcely to be distinguished. Artificial dis-
cipline was needless, when virtue pervaded every

» Fuller uses quite other adjectives.

VOL. 1. 12.

A History of Nursing

part of manners."1 This brief description of the
crusaders shows the type of men who later
became the knights of our order of hospitallers.
Their long and difficult march to Jerusalem, their
battles, victories, and defeats, their distresses
through massacres, conflagration, famine, and
pestilence, can only be touched on here, but a
pleasant and refreshing little glimpse of women at
their old familiar task is given by Mills :2 ; The
Christians, weary, thirsty, and oppressed with
labour and heat, would have sunk into despair
if the women of the camp had not revived their
courage, and brought them water from the stream.
The combat was renewed with tenfold vigour. '
In a later chapter he says that the women took
arms : ' Nor were the women to be restrained
from mingling in the fight ; they were everywhere
to be seen in these moments of peril and anxiety,
supporting and relieving their fainting friends."3
" Disease, that faithful companion of want, was
envenomed by the rains of the winter, the summer
heats, the unwholesome foods, and the close
imprisonment of the multitudes. ' ' 4 And when
after many terrible months the crusaders stood
at last victorious in Jerusalem, it was with a mere
remnant of their glorious army. Thus began the
Holy War which extended over many centuries
and was, " for continuance, the longest ; for money

1 Mills, History of the Crusades, vol. i., p. 138.

2 Ibid., vol. i., p. 142.

3 Ibid., p. 249.

* Gibbon. The Roman Empire, vol. vii., p. 219.

The Military Nursing Orders 179

spent, the costliest; for bloodshed, the cruelest;
for pretences, the most pious; for true intent, the
most politic the world ever saw."1

When in 1099 Godfrey was made King of
Palestine, one of his first acts was to inspect
carefully the hospital of St. John (no longer the
Almoner, but the Baptist), and he found it crowded
with wounded soldiers who loudly extolled the
humane attention they had received. Mills speaks
of this hospital as the ' ' great charitable establish-
ment for Christians at Jerusalem,' adding that
" it felt every gale of the political storm which
convulsed Palestine in the last half of the eleventh
century, and received new vigour when the crusa-
ders triumphed. So self-denying were the ad-
ministrators of this charity, that the bread which
they ate was made from the coarsest flour mixed
with bran, while that given to the sick was made
of the purest meal. ' The admiration excited
by the devotion of the brethren who w^ere caring
for the sick induced several crusaders of noble
birth to lay aside their arms, and join them in
their merciful work, and Godfrey was so grateful
for the benefits which he and his crusaders had
received that he endowed it richly with lordships
and dependencies in various parts of Europe.
His example was followed by other wealthy and

1 The Holy War, Thos. Fuller, p. 28.

2 Vertot, Knights of Malta, p. 14, vol. i.: "They clothed
again such as had been stripped by robbers; there the sick
were treated with care, and every kind of misery found in the
charity of these hospitallers a new hind of mercy to relieve it.1

i8o A History of Nursing

powerful crusaders, and in a short time, -we are
told, 'the Hospitallers had the revenues of a
great number of rich manors, both in Europe and
Asia, at their command."1 Up to this time the
hospital had been purely secular in government,
under the administration of Peter Gerard, who
was simply entitled ' Rector. ' A female branch
of the order was as old as the men's, for the care
of the sick and wounded made women necessary
from the very first, and a noble Roman lady
called Agnes was at the head of the sisterhood
which served the hospital of St. Mary Magdalene.
Nor were the females separated as nuns (which
became the case afterwards), but joined the
knights at table and in church, and by the
couch of sickness, and attended the strangers of
their own sex. Before the siege of Rhodes these
Sisters wore a red robe with black mantle, and
afterwards all black.2 When the order was first
dispersed, after the recapture of Jerusalem by the
infidels, it is not clear what became of the Sisters
of St. John, but they were subsequently found in
Spain, where they possessed valuable lands and
buildings. They also reappeared during the
thirteenth century in France in the hospital of
Beaulieu.

Whether the acquisition of so much valuable
property made it desirable to alter and enlarge
the scheme of government, or whether Gerard

1 Achievements of the Knights of Malta, Sutherland, p. 36.
- Helyot, Les Ordres Monastiques, vol. iii., p. 128.

Ancien habillement des Religieuses de 1'Ordre de S. Jean de Jerusalem de
THopital de Beaulieu, avant la prise de Rhodes
Helyot, Les Ordres Monastiques^ etc., vol. iii.,

The Military Nursing Orders 181

was so impressed with the importance and
sanctity of his office that he wished to enhance it,
or whether pressure from higher ecclesiastical
sources was the cause, soon after the Holy City
had become somewhat tranquil and settled the
Brothers and Sisters formed a religious fraternity
formally abjuring the world,1 and dedicated
themselves at the altar as the servants of the
poor and of Christ, under the rule of St Augus-
tine.2 The brotherhood assumed a regular habit:
a black robe, having a white linen cross of eight
points, symbolical of the eight Beatitudes, em-
broidered on the left breast, — what we now call
the Maltese cross. Fuller in describing their
dress said they wore on a black cloak the white
cross of Jerusalem, which is a cross crossed, or
five crosses together, in memory of our Saviour's
five wrounds. Jerusalem was now in the hands of
the Christians, and the story of the victory brought
multitudes of pilgrims filled with religious trans-
port to visit the Holy City and its sacred places.
As before, many at the end of their journey were
wayworn, sick, and destitute, and the Hospitallers
found steady employment in relieving their sad
conditions. The fame of the benevolent friars
spread abroad and they are described as "feeding
daily an innumerable multitude of poor, attending
to the sick, and comforting the dying, consecrating

1 The Order of St. John of Jerusalem, John Taaffe, p. 225.

2 Histoire des Ordres Monastiques, Religieuses, et Militaries,
Helyot, Paris, 1714, vol. iii., p. 75.

1 82 A History of Nursing

their days to deeds of mercy. ' So widespread
was the gratitude aroused, and so many were the
gifts, that it was said there was scarcely a province
in which the House of St. John did not own
manorial rights. So wealthy and extensive did
the order finally become that we are told it
possessed principalities, cities, and villages both
in Asia and Europe, and within the bounds of
Christendom had liens on no less than 19,000
manors. Fuller makes a caustic and character-
istic comment on the order, which had taken
solemn vows of chastity, poverty, and obedience.
1 But it is given, ' he says, ' to most religious
orders to be clear in the spring, and miry in the
stream. These Hospitallers afterwards getting
wealth, unlaced themselves from the strictness of
their first institution. . . What was their
obedience to their master, but rebellion against
the patriarch their first patron ? as shall be showed
hereafter. What was their poverty but a cozenage
of the world, whilst their order sued in forma
pauperis, and yet had nineteen thousand manors
in Christendom belonging unto them?' Their
revenue, says Mills, was more ample than the
largest demands of charity, and it led naturally
to an extension of their work. More and larger
buildings were erected for the reception of pil-
grims, and for the brothers who served them, and

1 Taaffe, p. 178 : ;< My order must not be men, but superior
to men," said Gerard.

2 The Holy War, Thos. Fuller, p. 52.

Religieuse de 1'Ordre de S. Jean de Jerusalem du monastere de Toulouse,

en habit de Chreur

Helyot, Les Ordres Monastiques, etc.

The Military Nursing Orders 183

the order enlarged its sphere by establishing
dependent hospitals in the maritime provinces of
the West. In these not only were sick pilgrims
cared for, but guides and convoys were supplied,
and information was given about transport by
ships and caravans. They were exempt from the
payment of tithes and were granted many privi-
leges by successive occupants of the papal chair. In
1118 the father and virtual founder of the order,
the peace-loving and charitable Gerard, died and
was succeeded by Raymond du Puy, a man of
entirely different type, bred in courts and camps,
haughty and warlike. Under him the order
changed and became distinctly military in charac-
ter - -a body of warrior monks who combined the
relief of the poor, the care of the sick, with the
duties of the soldier: 'two distinct professions,'
as Vertot says, 'seemingly opposite in their
natures.' He adds Their garb was plain and
modest; they reserved magnificence for the orna-
ment of their altars; and the poor pilgrim reaped
the advantage of the frugality of their tables. They
never left the apartments of the sick but to give
themselves up to prayer, or to take the field
against the enemies of the Cross. '

At some time during du Puy's administration
of about twenty-five or more years, the rules
of the hospital of St. John were definitely pro-
mulgated, and their influence on subsequent hos-
pital management was widespread and powerful.

i Vertot, The Knights of Malta, vol. i., preface.

184 A History of Nursing

That rule especially which related to the recep-
tion of patients dominated all hospital regu-
lations of the Middle Ages, and was repeated word
for word in most of the old regulations of the
Maisons-Dieu. Le Grand gives it as follows:

When the patient presents himself in the house
designated by th.2 Master he shall be received as
follows: having first confessed his sins to a priest
he shall receive the communion ; then he shall be
put to bed, and there he shall be treated as a
noble according to the resources of the house,
and every day, before the Brothers go to their own
meals, they shall charitably give him to eat."1
Le Grand further suggests the probability that
this was a formal asseveration of the customs
which had obtained in the ancient hospital as
conducted by the men of Amalfi, and therefore
probably dates back to the earliest Christian
centuries.

The hospitallers were now divided into three
classes: first, the knights, men of patrician birth
who bore arms and monopolised the dignities of
the order; second, the priests, who attended to
all religious duties in church, camp, and hospital;
third, the serving brothers or serjeus (half-knights) ,
who served as they were needed. (The word
scrjeus seems to have been used in an interesting
sense in ages when ideas of love and religion were

1 Statuts cT Hotels- Die u et dcs Leproseries : recueil de texies
du Xlle an XlVe Siecle; public par Leon Le Grand. Paris:
Picard et Fils, 1901. Introduction pp. ix.-x.

Grand-Maitre de 1'Ordre de St. Jean de Jerusalem

Helyot, Les Ordres Monastiques, Religieuses et Militaires, vol. iii., p. 74

The Military Nursing Orders 185

mixed, and Mills calls attention to the phrases
ser Jens de Dieu and scrjeus d' amour i>s com-
mon in. old authors, and to Shakespeare's
' affections men at arms.") When not engaged
in war the various duties of the hospital occupied
the knights, and it is said that not even the
heroes of Greece were more zealous than the
heroes of Palestine in healing the wounded soldier
and pilgrim. The fame of these warrior monks
soon filled all Christendom, and the youthful
chivalry of Europe vied with each other in the
wish to be enrolled under the White Cross banner. l
In a little while, we are told, the order was
crowded with noble and valiant knights from
every country, and the members were divided
according to their language into langites. As
the order grew in numbers and establishments, it
was still further divided into seven nations or
langues, viz., Provence, Auvergne, France, Italy,
Aragon, Germany, and England. So vast did
the property of the order finally become that in
order to administer it properly it became neces-
sary to divide it up into Commanderies, each
governed by a member of the order entitled
'Commander.' These in turn were divided into
priories, under the direction and control of a
' Grand Prior. ' Their treasury was considered
richer than that of any potentate of Europe, and
the chief of the order came to be considered the
most powerful prince of the East. At this period

1 The banner of St. John was a white cross on a red field.

1 86 A History of Nursing

there were said to be of knights, priests, and servT
ing brothers not less than 30,000 in number.1
In accordance with a papal edict the black habit
with the cowl and the white linen cross of eight
points was at first worn by all hospitallers.
At a later period, the Knights of St. John were
distinguished from the others by a white cross
upon a red ground. During the solemn and
impressive ceremonies with which a knight was
received into the order, the black robe was thrown
over him, and pointing to the white cross the
brethren said : ' We wear this white cross as a
sign of purity. Wear it also within thy heart as
well as outwardly, and keep it without soil or
stain. The eight points are the signs of the
eight beatitudes which thou must ever preserve,
viz.: i. Spiritual joy. 2. To live without malice.
3. To weep over thy sins. 4. To humble thyself
to those who injure thee. 5. To love justice.
6. To be merciful. 7. To be sincere and pure of
heart. 8. To suffer persecution. " 2 The form of

1 "At this period there was not a potentate in Christendom
who had not some Hospitallers in his Council. At Florence,
Pisa, and Verona they had magnificent hospitals and churches,
and the sisters of the order were esteemed as perfect models
of Christian virtue. It is told of Sister Ubaldina, of Pisa,
that she was the mother of the poor, the restorer of the sick,
the comforter of the stricken-hearted; there was no kind of
misery for which she had not a remedy or consolation."
Knights of Malta. Sutherland, p. 105.

2 " There is delivered them: i, a sword, in token that they
must be valiant; 2, with a cross hilt — their valour must defend
religion; 3, with this sword they are struck three times over

The Military Nursing Orders 187

government, we are told, was " aristocratical, '

•%

the supreme authority being vested in a Council
of Knights, of which the Master was president.
Whatever the form, the spirit animating it must
have been high and noble, for all writers agree in
praising their austerity of life; the great charity
which was as much a feature of the smaller houses
as of the hospital from which they sprang; the
purity of their lives, which we are told was ' no
less remarkable than their disinterested temper
of not appropriating anything to themselves. '
Andrew, King of Hungary, says of them: "Lodg-
ing in their houses I have seen them feed every
day an innumerable multitude of poor, the sick
laid in good beds and treated with great care,
the dying assisted with an exemplary piety, and
the dead buried with proper decency. In a
word, the Knights of St. John are employed
sometimes like Mary in contemplation, and
sometimes like Martha in action.'

About this time (1119 A.D.) appeared the Red
Cross Knights, or Templars, and they are referred
to here in order that they may not be confused

the shoulders, to teach them patiently to suffer for Christ;

4, they must wipe the sword — their life must be undefiled;

5, gilt spurs are put on them, because they are to scorn wealth
at their heels; 6, and then they take a taper in their hands,
for they are to lighten others by their exemplary lives; 7,
and so go to hear mass, where we leave them." —The Holy
War, Fuller, p. 53.

1 The Military Religious Orders of the Middle Ages, F. C.
Woodhouse, p. 46.

1 88 A History of Nursing

with the Order of St. John. The Templars were
originally formed for the sole purpose of guiding
and guarding pilgrims through mountain passes
and other difficult and dangerous places on the
way to and from Jerusalem. They were at first
a voluntary association of French gentlemen of
noble birth ( the Order of St. John was of Italian
origin), but later took the usual vows, adopted
a habit, and established a headquarters at Jeru-
salem near the temple, hence the name- -Templars.
From the fact that these first founders were sup-
posed to be pupils of the Hospitallers, and to
have subsisted several years upon their bounty,
some confusion has arisen about them. They
were never a nursing order. Unlike other re-
ligious orders, the Templars wore their beards
long. Originally they wore a white and later a
black habit (the white being a symbol of the
purity of their lives and professions, the black
being later assigned to the inferior officers), with
a red cross on the shoulders to remind them that
they must be ready to shed their blood in 'defence
of the faith. In battle their banner, half black
and half white, called Beauseant, was designed
to show that though fair to Christ's friends they
were black and terrible to His enemies. They
rose to great power and dignity and will be remem-
bered for the beauty of their churches, as the
hospitallers are for their splendid system of
hospitals. In their later years their great power
and wealth became the cause of their ruin.

The Military Nursing Orders 189

Still another order of knights hospitallers, of
German origin, was formed in 1191, called the
Deutsche Orden, or Teutonic Knights. Its actual
foundation had begun sixty years earlier,1 when
a German merchant from Bremen had founded
a hospital dedicated to Mary at Jerusalem for
male pilgrims of his own country, and his wife
had built a similar one for women.

The nursing staffs of these hospitals had at
first been affiliated with the order of St. John,
and as the work and numbers grew, and a com-
munity developed vowed to the service of the
sick and poor, and the defence of holy places,
Pope Clement III. first made it an independent
hospital order; and finally, in 1197, when a vast
concourse of knightly warriors were at Accon
and military feeling ran high, the brotherhood,
with pomp and ceremony, assumed knightly
duties under the direction of a Grand Master.
Their first hospital was destroyed by the fall of
Jerusalem in 1187, but was revived at the siege
of Acre, where German soldiers, in order to assist
the sick and the wounded, converted theii tents,
which were made out of the sails of ships, into a
temporary hospital. Members of the Teutonic
Knights Hospitallers were all at first of noble
family, and to the usual monastic vowrs of poverty,
chastity, and obedience they added a fourth vow
requiring them to care for the sick and defend the
faith. Over their black habit was svorn a white

1 In 1 12 V according to Herzog.

1 9° A History of Nursing

cloak with a black cross embroidered in gold on
the shoulder. They were divided into warriors,
nurses, and spiritual Brothers. They adopted,
for nursing, the regulations of the Knights of
St. John, and for war those of the Templars.1

These are the three great orders with whose
exploits the Middle Ages rang. The Knights
Hospitallers of St. John of Jerusalem were at
first a purely nursing order, and later became
military. The Knights Templars were al-
ways purely military. The Teutonic Knights
from the first had both nursing and mili-
tary duties. They were compared with the
mystic living creature seen by Ezekiel, having
the faces of a man and a lion, the former signifi-
cant of their charity in tending the sick, the latter
of the bravery with which they fought the enemies
of Christ. They became very strong in Germany,
and spread widely, many hospitals being given
over into their hands. In the i2th and i3th
centuries, with the rise of the middle classes,
the Teutonic order was strongly tinctured with
democracy, gaining thereby fresh strength, but
incurring the jealousy of the clergy.2

Another famous knightly order was that of the
Knights of St. Lazarus ; according to some histo-
rians it was the oldest of all the orders of hospital-
lers and sprang indirectly from the great hospital

1 Wetzer und Welte, art. " Deutsche Orden."

2 Offentliche Krankenpflege im Mittelalter, Dr. Victor
Fossel, 1900, p. 8.

The Military Nursing Orders 191

built by St. Basil in 370 at Cesarea, to which was
attached a house of separation for lepers. There
are even legends which seek to trace the leper-
serving order back to the very days of Christ
and of the Lazarus who was the brother of Mary
and Martha. Father Helyot discredits these le-
gends, and Creighton shows that there exist no
proofs that Lazarus, the brother of Martha,
ever had leprosy, but that a mist of religious
sentiment has merged the mythical beggar
Lazarus of the parable and the Lazarus who
was raised from the dead into one composite
figure.1 Helyot does not even agree that the
order of St. Lazarus as such dates as far back as
the days of Basil, but he mentions the belief of
those who hold that it was established under
Basil's rule, to serve in the many leper hospices
built after the pattern of the Basilias, and that
it was approved by Pope Damasus.2 At a later
date institutions similar to the Basilias were
formed in various places in the East, and one of
them apparently was in existence at Jerusalem
at the time of the first crusade. The buildings
were dedicated to St. Lazarus, the patron saint
of lepers, and styled Lazarettos.

While legend thus carries its origin back to the
fourth century, exact data only begin with the

1 History of Epidemics in Britain, Charles Creighton, M. A.,
M.D., Cambr. Univ. Press, England, MacMillan & Co,, New
York, 1891, vol. i , pp. 79, So.

2 Helyot, vol. i,, p. 258.

A History of Nursing

times of the crusades. The order received LS
members not only knights who had shared in the
wars of the crusades and who desired to devote
themselves especially to the care of lepers, but
also those who had themselves been stricken
with the dread disease. There were two bodies
of knights, the warriors, and the hospitallers.
There were also Sisters of the order. A statute
of the Lazarists made it obligatory upon them to
choose a Grand Master of noble family who was
himself a leper, and this curious rule was only
abrogated in 1253, when, all lepers of noble birth
having perished before the infidels, Pope Innocent
IV. gave permission to elect a non-leper to this
post. After the crusades, the order attained
wide recognition and prosperity in Europe. Chris-
tian princes bestowed lavish gifts upon it, and
its activity was immensely accelerated by the
bull of Pope Clement IV., which decreed that
lepers should be compelled to enter the lazarettos.
The kings of France gave the order rich posses-
sions in land, and assumed the privilege of naming
the Grand Master, whose seat was at Boigny.
In 1608 Henry IV. united the French branch with
the newly organised community of Our Lady of
Mount Carmel. Under the name " Knights of
Our Lady of Mount Carmel and of St. Lazarus"
the old regulations of the Lazarists disappeared,
except for one which bound them to the special
care of lepers; but the gradual cffacement of
leprosy from European society robbed the order

The Military Nursing Orders 193

of all that was typical in its form, and at the
time of the French revolution it was finally sup-
pressed. In Italy it had a similar history. In
1490 Innocent VIII. had declared it suppressed,
and issued a bull to this effect, which was disre-
garded in France, and only had the effect of
dividing the order. The Italian branch was
united by the Pope with the Knights of Malta
at the request of the latter, to whom the promi-
nence of the Lazarists was a cause of jealousy.
A later pope undid this union, and the order of
St. Lazarus again had a period of independent
existence until Pope Gregory XIII. 's time, when
he, having a preference for the order of St. Maurice,
amalgamated the Lazarists with it under a Grand
Master of his own choosing. By 1830 the com-
bined orders had ceased to exist.

The first Knights of St. Lazarus in Jerusalem
wore a plain cross on their mantle (of which the
colour is not known), with four arms of equal
length, somewhat flaring at the ends. The French
Lazarus cross was an eight-armed golden and
green or purplish-red cross with tiny golden lilies
in the corners. The Italian insignia was white
and green. l The emblem of the order of St. Lazarus
has in recent times become the heritage of the
German Nurses' Association. The name lazaretto

1 Das Lazaruskre^iz — unser Abzeichen; by Schwester Ch. v.
C., in Unterm Lazaruskreuz, Nov., 1906, No. 21, pp. 2, 3, from
data given by Heir Prof. Luthmar, Director of the Kunst-
gewerbeschule at Frankfort.

VOL. i. — 13.

i94 A History of Nursing

also lost its original significance and in time
was applied to military hospital wards, perhaps
through some sinister association of ideas with
venereal diseases.

We shall now return to the Knights Hospital-
lers of St. John. All through the thirteenth cen-
tury they fought bravely in defence of the Holy
Land, and dispensed to Crusader and Moslem
alike, when sick or wounded, the tenderest charity.
As for their hospitality, it was of so generous a
kind that never was the worn or weary traveller
turned from their door, and their expenses on
this account were among their heaviest. ' Hos-
pitality," they said, " takes the highest rank among
virtues. It includes all others."1 At the end
of the thirteenth century the last Christian strong-
hold in Palestine was Acre, and to defend it the
Hospitallers and Templars united against the
Sultan of Egypt, only to suffer a defeat so crush-
ing that every Templar was killed and but seven
Hospitallers escaped. This little remnant of the
order found temporary asylum in Cyprus, and
later, gathering their forces together, captured

1 "The duties of hospitality are three: to defend the guest
going and coming; to feed and lodge him when well; to try
to cure him when sick." — The Order of Knights of St. John
Jerusalem, John Taaffe, p. 149. It is probable that the hospi-
tality of the Brothers was sometimes taken advantage of, for in
later times they found it necessary to exclude from hospital
care assassins, highway robbers, incendiaries, sodomists,
conspirators, thieves, traitors, poisoners, debtors, false wit-
nesses, and sacrilegious persons.

Incien habillement des Chevaliers de 1'Ordre de St. Lazarus dansleQuinzieme

Siecle

Helyot, Les Ordres Monastiques, etc., vol. i., p. 257

The Military Nursing Orders 195

the island of Rhodes, which they held triumph-
antly against heavy odds for two hundred
years. In 1522 they were finally obliged to
surrender to Solyman, and for some years after
the Knights were without a headquarters, though
they still owned rich possessions in every country
in Europe. In 1530 the Emperor Charles V.
granted to them the isles of Malta, Gozo, and
Tripolis with all their fortresses and castles.
The first became their stronghold, and the closing
scene of their triumphs. The Knights have been
successively known as the Knights of St. John
of Jerusalem, the Knights of Rhodes and the
Knights of Malta, but, despite the diversity in
name, there was never any change in the order.
They were always the Knights of St. John. The
city of Valetta was founded by their Grand Mas-
ter La Vallette, and so magnificently fortified as
to command still, even in decay, the deepest
admiration and interest. At Valetta was estab-
lished in 1575 one of the largest and most im-
portant of the many hospitals of the order. The
Holy Infirmary of Knights of St. John is still
in existence and remains as a "magnificent monu-
ment of architecture." 1 It consists of a great
xgroup of buildings, -accommodating from 700
to 800 patients and containing under one roof
an enormous ward 500 feet long, 34 feet wide,
and 30 feet high, and various smaller wards,

i The Regulations of the Old Hospital of the Knights of Stm
John, by W. K. Bedford, 1882, p. ix.

196 A History of Nursing

offices, and kitchens, etc. Notwithstanding many
irregularities and later additions the whole con-
struction is considered to be of very great archi-
tectural beauty. The walls are thick and the
windows small and high, showing how lightly
sunshine was valued in those days. The dark-
ness of the large ward was relieved by tapestries
and pictures. In an old print the beds are shown
with curtains in the form of bell-tents, which we
may assume to have been either for the purpose
of securing greater privacy or of keeping away
mosquitoes and flies. A peculiar interest at-
taches itself to this institution because of the
remarkable splendour of its equipment and service. l
They were unrivalled in their day, and indeed,
with all the improvements in hospital service
which modern progress has brought, we would
find it hard to better some of these old regulations
of 1533. In reading them over one is struck
with the careful arrangements made for the divi-
sion of labour, and the proper conduct of the
work. The Grand Master of the order was
the superior or official head of the infirmary.
The Grand Hospitaller2 presided directly over it
and attended to its welfare. The Infirmarian, a
professed knight, was the actual manager of the
hospital, assisted by two knights called Prodomi.

1 The Order of the Knights of Malta is famous as the only
order that received insane patients. The History of European
Morals, by W. H. Lecky, vol. ii., p. 8g.

3 Chief of the French langue or community.

The Military Nursing Orders 197

The Infirmarian lived in the building, was re-
sponsible for its entire government, not only for
the discipline and good conduct of officials, but also
for the welfare of the sick to such a degree that
he was obliged to supervise the physicians when
treating their patients. These are his duties
and those of his two immediate assistants, as
defined by the regulations:

The Infirmarian is a professed knight, to whose
zeal the care of the sick is entrusted, whom he must
provide with beds according to their condition and
need. He resides in a separate apartment in the
Infirmary. Early in the morning he has the bell
rung for the visitation, at which he is present, to see
that the sick are carefully attended to by the phy-
sicians, and that what is necessary is ordered for them.
The time for dining arrived, he has the dinner-bell
rung to summon all the officials, and he is present
at the same to make sure that each of the subordinates
does his duty; and he does the same in the evening
at the visitation and supper. Above everything, he
must have perfect quietness observed, and therefore
he must often visit the beds at night, and the wards,
to look after the warders, lights, etc. l . . .

Two professed knights of integrity (commonly
called Prodomi) are appointed by the Most Eminent
the Grand Master, who must attend to the wants of
the sick, looking after the quality and quantity of
the allowances, the distribution of the medicines, and
all necessary provisions and food. They must also
note the daily expenses and consumption of things

1 Bedford, op. cit., p. 3.

A History of Nursing

in the Infirmary, signing with their own hand the.
vouchers for payments.

They provide many poor incurables, who are in-
capable of providing for themselves, with daily alms,
and distribute to others, in addition to what remains
in the caldrons, a large quantity of soup and ver-
micelli, which is cooked on purpose every day; also
a large number of old sheets and coverlets are given
to poor wromen, and many bandages and crutches
for cripples. They provide nurses, give them payment,
monthly, and clothing for the poor Foundlings, to
whom, when they are weaned, they give the neces-
sary food in the aforementioned place, La Falanga
[the foundling hospital]; and, finally, they superin-
tend the management of the hot baths and mer-
curial anointing, which are in a separate ward of the
Hospital.1

Every detail of work was carefully thought out,
and every office had its appointed officials.

The Armoriere was intrusted with all the silver
plate of the Infirmary which was used for the sick,

1 "How full of charity these first Hospitallers were! for
there is a description come down to our day of what was an
old custom in 1185 and would not be an old custom without
sixty or seventy years' standing, which brings us back to
Gerard's time — what care of Crusader's children . . . and
abandoned infants, and of alms to the imprisoned, and how
they should be clad as soon as liberated, of marriage portions
to poor girls, and of food and clothing to all who asked it
three times a week without limit as to number ; . . . that there
shall be workmen and a tailor's room for the indigent to
have their raiment mended every day, etc., etc." The
Order of Knights of St. John of Jerusalem, by John Taaffe
p. 178.

The Military Nursing Orders 199

and was responsible for its cleanliness and safe
custody.

A "Clerk of the Habit ': registered all the ex-
penses of the Infirmary in the principal ledger,
which was delivered every year to the Reverend
Chamber of the Common Treasury; was present
at the distribution of doles, and was intrusted
to draw up the wills of the sick. He lived in the
hospital and his task seems to have been
easy.

The Linciere had charge of all the linen and
furniture and bedding. He was allowed a paid
servant, and several slaves to clean, beat the wool,
and remake mattresses.

The Bottigliere took charge of all the wine,
bread, oil, etc., which he supplied according to
the vouchers of the Prodomi. He had a paid
assistant, and a room in the Infirmary.

There were two cooks, a purveyor and assist-
ants, who provided all the meat for the allowances,
which they could not receive into the kitchen
until after inspection by the Prodomi.

To assist the cooks and warders in the care of
dirty vessels and other mean offices, about forty -
four Christians and Turks were selected from the
Prison of Slaves, for whom there was a separate
Infirmary in the same prison.

The Holy Religion kept, besides, a paid
physician for a public daily lecture on anatomy;
and in order, more especially, that the beginners
might be trained, a public lecture was held

200 A History of Nursing

every Wednesday, at which ordinary diseases were
discussed.

The medical staff further numbered two ' ' prac-
titioners who must see that the surgeon's orders
are carried out," and six young men assistants
called barberotti, who were required to be on
duty in turn, not to ' leave the Infirmary with-
out proper assistance, especially in sudden

cases."

There was also a barber-surgeon or phle-
botomist, who had charge of the leeches,
cataplasms, vissicanti, etc., pertaining to .medi-
cal things, and had under him two paid young

men.'

We hear of but one woman, who was described
as 'elderly and experienced," living out of the
hospital, and taking care of the cases of scurvy.
The spiritual needs of the patients were met by
the chaplains, of whom ten were attached to
the Infirmary.

The Regulations of the Wards open with the
following interesting statement:-

Of the Wards.

The proper separation of the diseases and condi-
tion of the sick is observed in the Holy Infirmary,
and therefore every room has its different use :

. . . An old ward for the laity, religious orders,
and pilgrims.

A large ward for feverish and other slight ailments.

1 Bedford, op. cit., pp. 7-11.

The Military Nursing Orders 201

A small ward for serious cases and the dying, with
a room adjoining.

A new ward for those who suffer from hemorrhage,
with two rooms for those who undergo lithotomy. . . .

A room for mad people and their warder.

Two wards for those undergoing mercurial anointing
separate from the Infirmary. . . .

Of the Beds, Sheets and Coverlets.

The beds of the sick are changed from time to
time for requisite cleanliness, and they are remade
every evening by the warders, whose duty it is to
keep them clean.

The beds with curtains number in all 370, which
are changed in the summer for white linen curtains. . .

Those beds used by persons suffering from consump-
tion or other complaints are burnt, with all the
sheets and other things belonging, without any
reservation. . . .

The sheets are changed, without exception, accord-
ing to the needs of the sick, even though they should
require changing several times a day. . . .

The sheets as well as the coverlets, when old, are
distributed after a certain time to poor beggars by
the Prodomi.

Of the Silver Plate.

It contributes greatly to the dignity of the Infirmary
and to the cleanliness of the sick, their being served
night and morning with covers, bowls, and plates
of silver; . . . The slaves are supplied with pewter
utensils.

202 A History of Nursing

Here follows a long list of silver dishes, in-
cluding,

NUMBER

Bowls 250

Dishes 356

Cups 167

Basins 12

Spoons 256

Large Spoons 10

Forks 10

Quart-measures 43

Of the Hangings and Pictures.

For the greater comfort of the sick in winter, the
walls of the rooms are hung with woollen curtains,
xvhich are given into the care of the Linciere, who has
charge of them, and there are 131 of them. In the
summer time the rooms are ornamented wi*,h pictures,
which are well hung all about. . . .

Of the Quality of the Food.

The Prodomi, above everything, look after the
good quality of the materials used in the preparation
of the food, selecting always the best of everything;
and therefore the sick are given the best soups made of
gallinas, herbs, vermicelli, rice, and minced meat, and
every kind of meat which has been ordered them-
such as pigeons, fowls, beef, veal, game, forced meats
-in such quantities as are necessary; besides milk of
almonds, fresh eggs, plums, and raisins, and every
kind of refreshment allowed sick people — such as
restoratives, swreet biscuits, apples and pomegranates

The Military Nursing Orders 203

with sugar, and other sorts of confectionary — ac-
cording to the wants of each one. The knights and
persons of the Habit receive double portions.1

John Howard visited this hospital in 1786 and
recorded his impressions in vigorous English.
One feels, as one reads, that much of the spirit
and ideals of the founders had vanished, and in
thought anticipates the downfall of the order
which was complete a few years later. He says:

The windows, small as they are, are all close to
the roof, so that there is nothing for the sick to look
at, not even the sky, besides the dead walls and their
sick comrades opposite. Medical officers complain
of the bad moral effect produced on the sick by the
want of light and view, and state that their patients
come gradually to concentrate their whole thoughts
on their maladies. . . .

All of the patients lie single. In the largest ward
there were four rows of beds. . . . They were all so
dirty and offensive as to create the necessity of per-
fuming them; and yet I observed that the physician,
in going his rounds, wras obliged to keep his hand-
kerchief to his face. The use of perfume I always
reckon a proof of inattention to cleanliness and airi-
ness; and this inattention struck me forcibly on
opening some of the private closets, with which this
hall is very properly furnished.

There is a large apartment in which the governor
of the hospital resides during the two years of his
appointment. . . . He has a salary; and is gener-

1 Bedford, op. cit., pp. 14-19.

204 A History of Nursing

ally, as a sensible gentleman here told me, a young
and inexperienced person, others either not liking
the confinement, or being fearful of catching some
distemper. . . .

The number of patients in this hospital during
the time I was at Malta (29th March to igtb. April,
1785) was from 510 to 532. These were served by
the most dirty, ragged, unfeeling, and inhuman
persons I ever saw. I once found 8 or 9 of them
highly entertained with a delirious dying patient.
The governor told me that they had only 32 servants,
and that many of them were debtors or criminals,
who had fled thither for refuge. At the same time
I observed that near 40 attendants were kept to take
charge of about 26 horses and the same number of
mules in the Grand Master's stables, and that there
all was clean. I cannot help adding that in the
centre of each of these stables there was a fountain,
out of which water was constantly running in a
stone basin; but that in the hospital, though there
was indeed a place for a fountain, there was no
water.

'There is a great want of room in this hospital.
I requested that a delirious patient who disturbed
the other patients might be lodged in a room by
himself, but was told that no such room could be
found. Opposite to this hospital there is a large
house, which is now used only for a wash-house. A
great improvement might be made by providing a
wash-house for the hospital somewhere out of the
city (its only proper situation), and appropriating
these spacious and airy apartments to poor knights
and convalescent patients. The slow hospital fever

The Military Nursing Orders 205

(the inevitable consequence of closeness, uncleanliness,
and dirt) prevails here.

In the hospital for women there were 230 patients,
who had all separate beds. The governess attended
me through every ward, and was constantly using her
smelling-bottle; in which she judged very properly,
for a more offensive and dirty hospital for women I
never visited."1

The Order of St. John was established in England
in the year noo by some of the Brothers on their
return from Jerusalem. Their first house, always
the Chief House of the order, was the beautiful
priory at Clerkenwell, a "noble structure," con-
taining a church, a hospital, and an inn for the
knights, of all of which only one gate is now left.
This was built for them by a wealthy Norman
baron and his wife, who also built near-by a nun-
nery for religious w^omen, devoted to the service
of God and w^orks of charity. The only com-
munity of women which the order ever possessed
in England w^as in the priory at Buckland, in
Somerset, and was established- in 1166. Con-
temporary history shows that the knights in
England were of high consequence; the prior
was always a baron and had a seat in Parliament,
and they had riches and power — too much of
both probably, for in 1534 King Henry VIII.
abolished the order and seized their property,
alleging, however, as a reason their adherence to
foreign jurisdiction. Queen Mary restored the

1 Lazarettos and Hospitals , John Howard, 1789, p. 59.

206 A History of Nursing

British branch with all its privileges and pos-
sessions, because of its great services on behalf
of religion and humanity, making Sir Thos.
Tresham the Lord Prior. Elizabeth, however,
with characteristic vigour and thoroughness sup-
pressed it absolutely and finally.

The pride of riches and power, with the gradual
abandonment of the humbler humanitarian duties
for a spiritual dominance, had made the once
peerless order of serving brothers a menace to the
secular power. Dr. Fossel says 1 : Their vast
riches brought the order no blessing. From the
time of expulsion from the Holy Land the devo-
tion of the order to the calling of nursing grad-
ually waned. The warfare against unbelievers
occupied its whole attention, and in comparison
with this activity the works of mercy dwindled
almost to nothing."

In the early part of the nineteenth century
the English order was re-established, and in
certain European countries the knights still
survive, though entirely as a religious order, and
not as a military power. A recent writer says
that in 1837 the formalities of the order were still
observed with splendour in several continental
capitals.

Much more attractive, however, is the glimpse
we have of them during the terrible earthquake

1 Offentliche Krankenpfiege im Mittelalter, Dr. Victor
Fossel, Mitth. des Ver. der Artze in Steiermark, Nos. 4 and 5,
1900, p. 8.

The Military Nursing Orders 207

which in 1783 ravaged Sicily and Calabria, and
entailed great suffering upon the surviving in-
habitants. In this calamity the knights of the
order were found ministering to the needs of the
people, giving every relief in their power, and
showing the benevolence and active charity which
they seem to have possessed in a greater degree
than any other body of men during the period
of their greatest activity. The order has always
been essentially aristocratic, and the priors, who
have continued in regular succession, have fre-
quently been men of high rank. The members
devote themselves to humane and charitable work
such as founding cottage hospitals and con-
valescent homes and providing means for training
nurses for the sick poor. They provide con-
valescent patients in hospitals, without distinc-
tion of creed, with especially nourishing diet when
this is needed. They award medals and certifi-
cates for special service in the cause of humanity.
They founded the National Society for the Aid
of the Sick and Wounded in War; and also an
institution of widespread usefulness, the St. John
Ambulance Association, whose purpose is to popu-
larise instruction in ''first aid to the injured" in
peace or in war. In providing and maintaining
a complete ambulance service for use in the mining
and colliery districts they remind us of the merci-
ful deeds of the Miserere, the Brothers of Pity,
familiar in the streets of Florence. At the con-
ference assembled at Geneva on October 26, 1863,

208 A History of Nursing

which we now think of as the Red Cross Con-
ference, grouped around the delegates of the
fourteen governments which were represented
there, were found members of the Order of St.
John of Jerusalem. In the last Code of Statutes
of the society we find the membership to consist
of various high officials, but the foundation upon
which the whole structure rests is the "Serving
Brothers and Sisters," last named upon the list.
Of the articles defining the purpose of the order
the two following (the first and last) bring down
from the eleventh century the noble and the
humane spirit which forms their true and lasting
glory. The object and purposes of the order
are:-

i Generally the encouragement and promotion of
all works of humanity and charity in the relief of
sickness, distress, suffering, and danger, and the ex-
tension of the great principle of the order, "Pro utili-
tate hominum." . . .

1 6. Serving brothers and sisters . . . are chosen
from amongst those who, from a spirit of charity, de-
vote themselves to the care of the sick, and their
energies to the objects of the order.

Neither their riches, their power, nor their
dauntless courage, could give them the immortal
place in history to which they are lifted by their
deeds of charity and mercy.

In Germany the traditions of the Order of St.
John survive in the Johanniter and Johanniterin-
nen ; associations of men and women whose object

The Great Ward of the Hospital of the Knights of St. John
in Valetta, as it Appeared in the Seventeenth Century

From an old German work upon the Order, printed at Augsburg in
1650. The print represents the beds of the sick, with the
mosquito-curtains, and the knights in attendance on the
patients. In the foreground is a funeral ceremony

The Military Nursing Orders 209

is volunteer and charitable nursing. They train
nurses for such service by giving them a short
hospital course, and these are eligible for army nurs-
ing in war time. They thus continue to be identified
with the history of nursing, but all consideration
of their present status in the nursing world must
be relegated to a later chapter.

In our own country the name St. John is still
frequently associated with beneficent undertakings,
almost entirely related with questions of health
and sickness.

VOL. I. 14.

CHAPTER V

A GROUP OF SAINTS

St. Francis of Assisi.1- -Foremost and most effec-
tive of the nursing missionaries to the lepers in the
Middle Ages was Francis Bernardone of Assisi-
St. Francis, the founder of the celebrated order
of Franciscans or Brothers Minor, who, even as a
gay, care-free young cavalier, the son of well-to-
do parents, looked with mingled aversion, pity,
and brotherliness on the miserable objects met
in his pathway on his jaunts. Even before he
had renounced the life of ease and wealth wrhich
might have been his, or dreamed of his mission
in preaching and living a life of poverty, and while
his evenings were still being spent in carolling
serenades with other young men through the
steep streets of Assisi, he began, almost without
knowing why, to visit the lepers in their refuges
and to care for them in divers ways, not only
by giving alms, but also by personal service.

1 References : Life of St. Francis, Paul Sabatier, trans, by
Louise Seymour Houghton, Charles Scribner's Sons, New
York, 1894; The Story of Assist, Lina Duff Gordon, 1900;
The Little Flowers of St. Francis, trans, by T. W. Arnold,
1901.

2IO

A Group of Saints 211

Although they were not the moving cause of the
final turning of the vivacious, nature- and music-
loving young Italian to a self-denying, religious
life, the lepers were closely associated with his
hours of spiritual awakening, and were always
a special object of his interest and care. Francis
was born in 1182, and during his life of forty-
four years, a genuine revolution in the social status
and general conditions of the lepers took place.
The secret of the success of this reform must have
lain mainly in the fact that Francis and his fol-
lowers lived with the lepers much as they would
have lived with other people — not going into
banishment for their sakes or cutting themselves
off from the world, but keeping up their work of
preaching and teaching, while making their
homes with the lepers. Francis himself, im-
mediately after his first farewell to his father's
house, betook himself to a leper settlement, where
he lived until the plans for his future had gradu-
ally shaped themselves; and here his friend Ber-
nardo joined him and shared his little hut. The
whole question of the treatment of lepers, says
Knox-Little, 'wras one of the great social diffi-
culties of the time. . . . The leper lost all his
rights ... ; he had no occupation ... ; he had
no civil rights even in making a will or handing on
his property. . . ; his acts were void in law. . .
To suffer from this disease was absolute degrada-
tion. It is evident that the wisdom of the time,
medical and social, was entirely at fault in view

' -j

212 A History of Nursing

of this tremendous and increasing social evil. . . .
St. Francis saw how important it was for mankind
that the leper question should be dealt with
thoroughly. Men of all ranks entered the Francis-
can Order, . . . men of culture, of considerable
means, and of noble birth. No matter who they
were, he insisted on their dwelling in the leper
hospital and attending to the sufferers. It fol-
lowed that something like improvement in the con-
ditions of the towns was begun, and something
like a proper treatment of the disease. From this
followed in course of time the complete annihilation
of the scourge in Europe, which . . . was really
the work of St. Francis."

It was for years the custom of the Brothers
Minor to go from lazaretto to lazaretto, spending
the nights in the leper colonies and by day preach-
ing in the villages and surrounding towns. An
order of brothers called the Crucigeri or Cross-
bearers had been created in Italy especially to
assume charge of the lepers, but they often lost
their patience in face of the exactions and in-
gratitude of their charges . Perhaps it was because
they were too closely confined with them, or
that they lacked the intense love of all created
things that irradiated the heart of Francis. At
any rate, they welcomed, as well as they might,
the aid of the latter and his friars, and often a
Brother of St. Francis was put in charge of a
single leper for a long service.1 The following

1 Sabatier, op. cit., p. 142.

A Group of Saints 213

tale taken from Sabatier well illustrates the
nursing side of Francis's mission :

It happened one time that the Brothers were
serving the lepers and the sick in a hospital near to
the place where St. Francis was. Among them was
a leper who was so impatient, so cross-grained, so
unendurable, that, every one believed him to be
possessed by the devil; and rightly enough, for he
heaped insults and blows upon those who waited
upon him, and, what was worse, he continually
insulted and blasphemed the blessed Christ. . . .
The Brothers would willingly have endured the in-
sults and abuse which he lavished upon them, in order
to augment the merit of their patience, but they could
not consent to hear. . . . They therefore resolved
to abandon this leper, but not without having told
the whole story exactly to St. Francis, who at that
time was dwelling not far away.

When they told him, St. Francis betook himself
to the wicked leper. 'May God give thee peace, my
most dear brother, ' he said to him as he drew near.

;'And what peace,' asked the leper, 'can I re-
ceive from God, who has taken away my peace and
ever)'' good thing, and has made my body a mass
of stinking and corruption?'

St. Francis said to him: "My brother, be patient,
for God gives us diseases in this world for the salva-
tion of our souls, and when we endure them patiently
they are the fountain of great merit to us. '

1 How can I endure patiently continual pains \vhich
torture me day and night? And it is not only my
disease that I suffer from, but the friars that you gave

£i4 A History of Nursing

me to wait upon me are unendurable, and do not
take care of me as they ought. '

Then St. Francis perceived that this leper was
possessed by the spirit of evil, and he betook himself
to his knees in order to pray for him. Then return-
ing he said to him: "My son, since you are not satis-
fied with the others, I will wait upon you. '

'That is all very well, but what can you do for me
more than they?'

'I will do whatever you wish.'

'Very well; I wish you to wash me from head to
foot, for I smell so badly that I disgust myself. '

Then St. Francis made haste to heat some water
with many sweet-smelling herbs; next, he took off
the leper's clothes and began to bathe him, while a
Brother poured out the wrater. "*

The story goes on to say that the leper was
miraculously healed, but such an event would
hardly be necessary to enable us to appreciate
what it must have meant for these poor banished
sufferers to have the friendly companionship as
well as the kindly practical services of these
willing followers of the sweet-natured and clear-
sighted Francis.

The Sisterhood of the Poor Clarisses was pre-
sided over for forty years by Clara, the highborn
maiden who, at seventeen, slipped from her father's
house at midnight to exchange her festal dress
for the browTn robe of a nun and to have her

1 Sabatier, op. cit., p. 142, adds: "All the details of this
story lead me to think it refers to Portiuncula and the hospital
San Salvatore delle Pareti."

A Group of Saints 215

beautiful hair cut on the altar. This order also
did some nursing work to help Francis and his
Brothers in their mission. The story of Francis
and Clara constitutes a veritable poem, impos-
sible of repetition and almost of comprehension in
an age other than one of marvellous lives and
deeds. No trace of any earthly feeling save
ideal friendship seems to have existed between
these two, who were friends throughout their
lives. Clara, after a short sojourn in a Bene-
dictine convent, went to live with a little com-
munity at the church of San Damiano, which
Francis had built with his own hands. The Sisters
were also vowed to absolute poverty, but the
Brothers promised to work or beg for them, to
supply their needs, and they in turn undertook
to do such services for the Brothers and for the
churches as lay within their power. Thus they
spent much of their time in weaving the linen
altar cloths which the friars gave away to poor
churches, and in mending their clothes. Outside
of their church were some little mud huts, and
here they received and nursed the sick that
Francis sent to them, so that finally San Damiano
became a sort of hospital, and nursing one of the
chief interests of the community. The whole
account of the life there is incomparable in its
singular simplicity, and perhaps the nursing
in the little mud huts was equally unworldly
and archaic.

As Francis neared the end of his life we find

216 A History of Nursing

a pathetic story of the manner in which he was
treated in his last illness, which makes one pity
the patients of that day with a deep pity. Phy-
sicians are spoken of several times in the life of
Francis. "The best doctors for the eyes were
at Pieti," and in his last illness several attended
him. Sabatier writes: 'The doctors, having
exhausted the therapeutic arsenal of the time,
decided to resort to cauterisation: it was decided
to draw a rod of white-hot iron across his forehead.
When the poor patient saw them bringing in a
brazier and the instruments he had a moment of
terror; but immediately recovering himself, 'Bro-
ther fire/ he said, 'you are beautiful above all
creatures: be favourable to me in this hour.' The
experiment was no more successful than the other
remedies. In vain they quickened the wound
on the forehead by applying plasters, salves, and
even by making incisions in it: the only result
was to increase the pains of the sufferer." *
Francis died in- 12 26, and Clara survived him for
some years. After her death the order underwent
many variations and modifications. Nursing was
not pursued as an interest, but the nuns performed
some kind of manual labour daily.2 In general the
order, known at different times and in different
countries as the Order of Poor Ladies, Clarisses,
Minoresses, and Poor Clares, has been conducted
on austere contemplative lines.

1 Sabatier, op. cit., p. 312.

2 Tuker and Malleson, op. cit., part in., p. 150.

A Group of Saints 2 1 7

One of the creations of Francis which has most
widely perpetuated his spirit is the Third Order,
or that of the Tertiaries. The Third Order really
represented a revival of the early Christian spirit
and mode of showing kindness and charity. It
was established in order that men and women
living in the world, and in family relations, who
could not possibly leave their ties and duties for
the life of the religious orders, could yet be as-
sociated with them in sympathy and good works,
but without any bond. Certain of St. Francis's
biographers tell us that the idea of the Third
Order came suddenly into his mind one day,
when, as a result of his preaching, a whole village
followed him, and would fain have become his
disciples and renounced all to do so. Too full
of real wisdom to encourage such a step, he told
the people that he would give them an order
which they could join while remaining in their
places in the world. As time went on, many
Tertiaries formed communities, and convents of
Tertiaries arose in different countries.

There are now a great many separate founda-
tions of Regular Tertiaries, founded by individuals
for various works of charity, among which nursing
is always included, and new ones are often formed.
They are sometimes called Diocesan Tertiaries,
having a simple approbation from the bishop.1

The Tertiaries in community lived a religious
life and took the three customary vows of poverty,

1 Tuker and Malleson, op. cit., part iii., p. 153.

218 A History of Nursing

chastity, and obedience, but not solemn vows;
hence their freedom to devote themselves to all
kinds of active work. Other orders did not long
delay in adapting this flexible mechanism to
their own uses, and there arose Dominican and
Augustinian Tertiaries, and much hospital nursing
was given over into the hands of the Third Order.

Many famous nursing saints have been en-
rolled in the Third Order of St. Francis, among
them Elizabeth of Hungary, Louis of France,
Elizabeth of Portugal, Isabelle of France, Anne
of Bohemia, Bridget of Sweden.1

Elizabeth of Hungary. — Contemporary with St.
Francis was one of the most beloved saints and
nurses of the Middle Ages, Elizabeth of Hungary-
the Mother of the Poor, die liebe Fran Elisabeth-
prominent in art, legend, and history as a patron
saint of nursing, charity, and the protection of
children, the heroine of the story of the miraculous
roses and the inspiration for Wagner's exquisite
creation of Elizabeth in Tannhauser: The legend
of a star foretelling the time and place of birth
has been attached only to the most revered of
those who have been the objects of popular affec-
tion, and this legend has been told of Elizabeth.
She was born in 1207, the daughter of Andreas II.,
King of Hungary, and was married at fifteen to
Ludwig, son of the Landgraf of Thuringia, to
whom she had been betrothed in her cradle. She
was beautiful, of the dark Hungarian type, frail

1 Tuker and Malleson, op. cit., part iii., p. 164.

Ancienne hospitaliere du Tiers Ordre de S. Francois

dite de la Celle
Helyot, Les Ordres Rlonastiques, etc.

A Group of Saints 219

of physique, but with a rare mind and soul;
passionately devoted to poor and humble people,
pathetically unselfish and simple, caring nothing
for pomp and state, yet able to wear royal robes
with a grace that fascinated guests and strangers.
Her union with Ludwig was an ideal one. They
adored each other, and the young knight alone
of his family was made of the fine clay capable of
appreciating Elizabeth, for from the others she
encountered only coldness and jealousy. From
the heights of the Wartburg she loved to go down
into Eisenach and visit the villagers, though on
her return she had to run the gauntlet of sneers
from her high-born companions, who derided her as
a "beguine" and lamented that there was so little
of the princess about her. It was her custom to
go daily wherever there was sickness, to carry
supplies, and to nurse the sufferers. Newr-born
babies and their mothers were her great care, and
she bathed, dressed, and attended them untir-
ingly. It was on one of these journeys that the
incident of the roses is said to have happened.
According to some accounts the stern Landgraf,
her father-in-law, and to others her cruel brother-
in-law, always furious because she spent so much
money in charity, stopped her angrily as she came
down to the village, and demanded to know what
she had under her cloak. But the genuine
folk-tale1 is that her husband himself, as he was

1 The Life of St. Elizabeth, by Montalembert, 1904, has been
taken as the leading authority.

220 A History of Nursing

returning from the hunt, and knowing well \vhat
she had behind her cloak — bread, meat, and
wine, — stopped her in an affectionate teasing
way and insisted on pulling her cloak open and
seeing what she was carrying away. Then, when
the armful of red and white roses was disclosed on
the midwinter day, taking one reverentially from
her he went his way awe-stricken at this proof
of his wife's angelic nature. Montalembert, who
says that he heard this legend from the peasants
of Marburg in 1834, adds that, as they tell it,
Ludwig kept the rose all his life. None of her
prodigalities disturbed her husband. Even when
his mother, in a fury, took him to see the little
leper boy, Helias, tthat Elizabeth had brought
into her own room and put to bed, he only smiled.
Here legend again symbolises the tale, for the
story runs that, when his angry mother, hoping
to turn her son against his wife, pulled down the
covers, there, instead of the leper boy, was seen
the figure of the Crucified One. 'Among all the
unfortunates who attracted her compassion,"
says Montalembert, ' those who had the largest
place in her heart were the lepers."

It was a time when the distress of the poor
was arousing all kindly hearts to help. In 1226
came a famine, and Elizabeth with extraordinary
energy and executive ability had bread baked
and distributed systematically to from 300 to
Q oo poor daily at the gates of Wartburg. She
and her husband both had already built hospitals.

Laurent, photoj.

Murillo

St. Elizabeth Attending to her Patients
In the Madrid Academy St. Ferdinand

A Group of Saints 221

Ludwig had erected a xenodochium at Mencken,
and Elizabeth had built a small hospital, holding
twenty-eight patients, on the side of the Wurtburg
on the road to the castle, and on a site later
occupied by a convent. Even the stones of this
building are now gone, but the spring of water
is still called St. Elizabeth's fountain. She also
built two hospices in Eisenach, of which one,
St. Ann's hospital for the sick in general, is still
in existence. The other, a heilige Geist Spital,
was for poor \vomen. Elizabeth's whole time and
strength were devoted to nursing. Twice a day
she went to the hospitals to care for the most
wretched patients, bathing them, dressing their
wounds, and taking them nourishment; "all,"
says Montalembert, "with a gaiety and amenity
of manner which nothing could disturb." Sick
children always attracted her special care and
tenderness. She did not forget toys to cheer
their spirits, nor fail to play with them for a little
while after her wTork was finished. She herself
first became a mother at sixteen, and children are
always associated with her in wwks of com-
memorative art. She had, in all, four children.

The departure of her husband on one of the
crusades and his untimely death in 1227 made
an end to the happiness of Elizabeth. Her
brothers-in-law, Conrad and Henry, totally out
of sympathy with her almsgiving, drove her from
her home in the Wartburg. The old pictures in
Marburg showT her descending the hill in mid-

222 A History of Nursing

winter with her little children, and many are the
romances told of her humiliation, the ingratitude
which she received on all sides and the misery in
which she sought shelter from house to house,
only to be turned away, and how she was finally
given lodging in an outhouse of an old inn-keeper.

The legends were, of course, the delight of nar-
rators, and the more inhuman the insults heaped
on her, the greater the contrast with Elizabeth's
sweetness of character. But no nurse who has
had experience in work among the poor could
ever believe that she was thus cruelly turned away
in her extremity by all her old patients, although
some may have feared to succour her through dread
of the wrath of the vindictive brothers. More
prosaic chronicles simply say that on leaving the
Wartburg Elizabeth went to her aunt, who was
Abbess of Kitzingen, and that later her uncle, who
was Bishop of Bamberg, built for her the castle of
Pottenstein, where, with her court, she lived until
her husband's body was brought back from the
Orient.

Her husband's knights and companions-at-arms,
charged by him to protect Elizabeth, now de-
manded justice for her, and she was reinstated
in the Wartburg, after accompanying Ludwig's
corpse to Reinhardsbrunn, wrhere it \vas buried and
where she built a hospital { in commemoration of
him. In this hospital she received the most

1 Virchow says Ludwig himself had built this hospital.

A Group of Saints 223

especially pitiable cases and devoted herself to
the most arduous nursing.1

In 1228 she returned to the Wart burg, and,
her fortune having been restored to her by
the Pope's order, she continued her charitable
works. She now, as it is generally supposed,
built the hospital of Maria Magdalena at Gotha,
which was rebuilt in 1541 by the city govern-
ment. (Virchow assumes that she and Ludwig
together built this hospital in 1223, though he
quotes other writers as dating it from 1229.)
In 1229, the castle of Marburg with a rental
having been settled on her, she went there to
live, and built the hospital dedicated to St.
Francis in which she ended her days. While it
was being finished, her castle being inaccessible
and inconvenient, she stayed in the little village
of Wehrda; but as soon as it was done she
moved into it, and took up the work of nursing
there to the exclusion of all else, her own little
children having been separated from her by
her confessor, a man of peculiarly odious char-
acter. There, worn out too early by the vicis-
situdes of her life, she died at the age of twenty-
four, and was buried in the chapel of the hospital.
The hospital, though small, \vas always full, for
the fame of Elizabeth had spread far and wide.

1 Geschichte des Hospitals S. Elisabeth in Marburg, C. F.
Heusinger; Schriften der Gesellsch. zur Beford. der gesamten
X at itrivis sense haf ten zn Marburg, 1872, vol. ix, pp.
69-149.

224 A History of Nursing

It stood, when built, almost in primeval forest,
but after her death the reports of her saint-
liness and her cures brought thousands of pil-
grims yearly, and the town grew up gradually
about the hospital to its present size. The riches
brought by the numerous pilgrims made the
hospital and its little chapel a valuable property,
and after Elizabeth's death there were many
claims and counter-claims among her noble
relatives for its control. The Johanniter Orden
(Knights of St. John) and the Deutsche Orden
(Teutonic Knights Hospitallers), which had been
founded in the Orient for hospital service, both
claimed it. It was finally put in charge of the
latter. The Teutonic Knights, by reason of their
warlike tendencies, degenerated as a nursing
order even more rapidly than the Knights of
Malta, and the little hospital passed through a
series of vicissitudes until, at the time of the
Reformation, the relics of St. Elizabeth were
scattered and the control passed into other hands.
In 1811 by royal decree the buildings of the
then existing hospital were given over to the
university.1 The original hospital of Elizabeth
stood by or near the present church of St. Eliza-
beth in Marburg. Outside of her own work as a
nurse, it is supposed that the nursing in the vari-
ous hospitals founded by Elizabeth was in general
carried on by the order of St. Lazarus, which

1 Heusinger, op. cit.

A Group of Saints 225

she is said to have introduced into Germany from
Hungary. 1

Lay physicians, Heusinger again reminds us,
did not then exist in Christian countries. The
professors at the newly established universities
of Vienna and Prague were chosen from among
the clergy, and medical practice was entirely in
the hands of monks and nuns. As there was no
way to obtain any scientific study except through
theology, there was in Silesia, as elsewhere, no
example of an educated physician in secular life.
The only seculars were ' bonesetters ' or sur-
geons of homely manual skill, with no education.

A mutual regard had existed between Francis
of Assisi and Elizabeth, although they never met.
Each, however, had heard of the works and good-
ness of the other, and, to express his sympathy
and fellow-feeling for Elizabeth, Francis, having
nothing else, sent her his old grey cloak, which
she prized highly and loved to wear. Elizabeth
herself would fain have been a mendicant, and
in 1229 or 1230 she joined the Third Order with
solemn vows; being, Helyot tells us, the first
Franciscan Tertiary to take vows of this character.
The Grauenschwestern or Gray Nuns of the thir-
teenth century, who were also Tertiaries of St.
Francis, were often called Sisters of St. Elizabeth
because they had chosen her as their patron saint.

1 Zwr Geschichte des Aiissatzes und dcr Spitaler besonders
in Deutscliland. Virchow, Archiv. /. -path. Anat. 1860, 2nd
art., vol. i8,p, 313.

VOL. I. 15.

226 A History of Nursing

Elizabeth was related to a notable group of
idealists and humanitarians of that time who
belonged to the famous family branches of the
Counts of Andechs and Meran.

Virchow says of the members of this family, for
centuries prominent in the social life of Southern
Germany, that their good deeds were innumerable.
A strain of noble elevation of mind and spirit dis-
tinguished them. The men were of the purest
type of chivalry, and not a crusade went forth but
included knights of Andechs and Meran, while
the women were untiring in hospital and nursing
work, and several are now classed among the
saints in recognition of their labours of love. One
of these women, Hedwig, who married the Duke
of Silesia, was Elizabeth's aunt; another was
Anna, the daughter-in-law of Hedwig, and another
was Agnes of Bohemia, Anna's sister. Hedwig
and her husband built a hospital for leper women
at Neumarkt in 1234. A hospital founded at
Trebnitz at an earlier date (1203) is attributed
to Hedwig, and a notable one, — one of the earliest
examples in Germany of the afterwards widespread
hospitals of the Holy Ghost, founded at Breslau
in 1214 for incurables and chronics, the poor,
and strangers — to the Duke of Silesia.

Anna built a hospital in memory of Elizabeth
in 1253 in Breslau, and Agnes had built St. Peter's
hospital in Prague about 1234. An ancient
chronicle says of Agnes of Bohemia : ' She gladly
extended her kindness to those who were ill;

A Group of Saints 227

she spread soft beds for them; she carefully re-
moved all that could distress eyes and nose;
she prepared food with her own hands, and cooked
it that it might be served to taste, with untir-
ing energy, that the sick might be freed from
ill, pains diminish, illness yield and health
return,"

All of these women worked daily and untiringly
themselves as nurses in the hospitals, and in the
homes of the poor of the cities. The old records
speak of Hedwig's ;' great tenderness," and a
miniature shows her dressed in a simple garb
suited to hospital work, in the act of performing
her various duties. In one, she urges the cause
of the poor upon her husband; in another, she
presents the poor with a house; she washes and
kisses the lepers' feet; she feeds the sick in their
beds, gives food to the poor, ministers to a prisoner,
gives alms to a pilgrim.1 (The seven virtues.)
A hospital at Kreuzberg, also attributed to one
of these good women, that at Neumarkt, and the
one in Prague, still remain. The spread of
leprosy (which had invaded Europe in the sixth
and seventh) in the thirteenth century had been
appalling, and corresponding efforts to meet the
situation were put forth by all charitable persons.
It is estimated by Toilet that there were 19,000
leper hospitals in the thirteenth century. Virchow
says that hundreds upon hundreds of hospitals
were erected for lepers during the twelfth, thir-

1 Eckenstein, op. cit., p. 294.

228 A History of Nursing

teenth, and fourteenth centuries, 1 and in Germany
alone he mentions an extraordinary number by
name and gives the dates of their foundations.
In Silesia the need was especially urgent, and an
enormous number of hospitals was built. No-
where else, he adds, were the nursing orders more
systematically developed and distributed. The
nurses for the leper hospitals were supplied almost
entirely from the various branches of the order
of St. Lazarus. In the hospitals founded by the
women of the family of Andechs and Meran a
branch of the Lazarus order wearing the cross
with a red star was active, and Anna herself nursed
in Prague under this emblem. Besides hospital
work, visiting nursing was continually practised

1 An adequate study of the history of lepers would form
a book in itself. The treatment of the lepers in the Middle
Ages reflects every humane and merciful impulse known to
the human heart, and, equally, every possible phase of super-
stitious error. Beside the social stigma, too well known to
dilate upon and still existing, they received at times a certain
veneration, as beings on whom God had by direct permission
laid a calamity which set them apart; thus L6on Le Grand,
in his compilation " Statuts d'Hotels-Dieu et des Leprose-
ries" alludes to the custom in many leper hospitals of calling
the patients "Brother" and "Sister" and appointing a re-
ligious rule for them, in the belief that it was the purpose of
God to turn them to the religious life: on the other hand they
encountered a popular detestation which culminated hide-
ously in a general persecution of lepers in France about 1321 ,
on the accusation that they were about to poison the wells.
King Philip issued a proclamation declaring that the land
must be cleared of the guilty and superstitious brood of
lepers, and many were burned. See History of Latin Chris-
tianity, H. H. Milman, 1881, Book XII., chap. vi.

The banner of a Flemish lazaretto with the arms of the Gruthuyse fam-
ily, dating from 1502. From a painted curtain preserved among the Col-
lection of Engravings in the National Library. The picture refers to the
life of St. Lazarus. In the middle are the Virgin and St. Lazarus, the
latter with traces of the sores which the dogs licked. In the top medallion
to the left is the rich man driving Lazarus from his door. Opposite,
Lazarus is standing at the rich man's door, while a dog licks his sores.
Below, the rich man is upon his death-bed, with an evil spirit waiting to
carry off his soul. Upon the opposite side, Lazarus is lying dead upon the
bare ground, but a dove is bearing his soul to heaven. The donors of the
banner are kneeling before the Virgin and St. Lazarus. The clapper (which
was used to announce the approach of the lepers) is depicted eight times
in the border.

Military and Religious Life in the Middle Ages and at the Period of the Renaissance,
by Paul Lacroix. Pub. by Bickers & Son, London

A Group of Saints 229

by these now sainted nurses. They paid great
attention to the care of obstetrical patients in
their homes, and combined in themselves all the
functions of the physician, the relief agency, and
the nurse.

St. Catherine.- -It was a unique characteristic
of the nursing of mediaeval times that it often
formed a background, as it were, in the lives of
men and women who in the foreground played
most dramatic and extraordinary parts upon life's
stage. Of no one is this more strikingly true
than of Catherine Benincasa of Siena, born in
1347 A.D., the daughter of humble, respectable,
and prosaic Italian parents. How these good
plodding folk came to have a daughter of such a
highly- wrought psychical nature was a puzzle to
themselves, which they finally accounted for, as
did others, by revering her as a saint, Catherine
early showed an intense asceticism (the accounts
of which, however, are probably exaggerated)
and an amazing mental gamut of mysticism and
ecstasy, associated, however, at times with sound
common-sense and a keen perception. Add to this
a passion for serving humanity and a truly as-
tonishing energy and nervous force in work, and
it is not hard to understand the reverence in which
she was held in that vividly picturesque and
highly credulous age. Catherine lived only thirty-
four years, but in that time she was hospital nurse,
prophetess, preacher, and reformer of society
and of the Church. Yet with it all, she was ever

230 A History of Nursing

the daughter of the house, ready to sweep and
clean and do the humblest household tasks. The
house in which Catherine lived is still standing,
in good repair, at the end of the narrow Sienese
street, and her little cell-like bedroom with her
stone pillow on the floor is visited daily by curious
and sympathetic travellers. Beside the stone
pillow stands the little lamp which she carried
with her on her nightly visits to the hospital, La
Scala. It is quite a walk from the house to the
hospital, and Catherine was a young girl when she
first began going there morning and evening to
bathe and dress the old leper woman Lecca, the
grumbling and ungrateful one whose condition
was so dreadful that it sickened every one else,
and Andrea, one of the old Sisters of Penance,
dying of cancer and so disagreeable that no one
else could endure her. The latter calumniated
even the gentle nurse who waited upon her, so
that the mother of Catherine would fain have
stopped her daughter's visits to the hospital.
In 1372, when the plague was epidemic in Siena
for more than a year, Catherine rarely went home,
but walked night and day in the wards, only rest-
ing for a few hours now and then in an adjacent
house. But few details, however, of her nursing
work are left, probably because the distinguished
political part which she played overshadowed
her supposedly more humble tasks.

To-day one could hardly imagine a nurse turning
from hospital work to admonish the Pope himself,

A Group of Saints 231

but such was Catherine's prerogative. The Flor-
entines, always in a turmoil, and having now
quarrelled with and having been excommunicated
by the Pope, turned to Catherine as a peacemaker
because of the fame of her extraordinary sanctity.
The Pope had fled to Avignon, and Catherine,
accepting the mission of the Florentines, went
there and was received with honour and reverence
by the whole papal court. No matter how her
mental supremacy is to be explained, it is surely
an impressive sight to see this fearless woman,
exalted with the belief in the truth of her message,
standing before the Pope and his staff with advice,
warning, and denunciation. Her mind dominated
the situation. Not only did the Pope constitute
her his arbitress with the Florentines, but fol-
lowing her counsel he returned to Rome, whither
she accompanied him, partly to protect him by
her prestige, partly to keep up his own uncertain
courage. Catherine's numerous letters to per-
sonages high in state and church are still extant,1
and constitute a notable study in psychology.
Though much in them is displeasing to the modern
mind, they should always be taken in connection
with her actual life of unselfish practical service.
It is, perhaps, hardly to be wondered at, that a
celebrated physician of her day, Gutalebracia,
disbelieved in her visions and prophecies, and
in an interview tried to confute her. According

1 St. Catherine of Siena as Seen in her Letters, Vida D. Scud-
der,

232 A History of Nursing

to her biographers, Catherine on this occasion
defeated the sceptic by taking her stand on the
plain, practical ground of the Golden Rule and
refusing to be led into any subtleties or mysticisms.
Early in life Catherine had joined the Tertiaries
of St. Dominic, an order founded in imitation of
St. Francis's Tertiaries. She died in 1380 A.D.
Like all other great saints Catherine has been a
favourite subject for painters. She is often pictured
in the act of expelling demons (a favourite sym-
bolism for nursing and medical saints) or in an
ecstatic state, with her emblems, the lily, the
thorn, or a book.

Old Cloister in Ravenna, now the Ospedale Civile

CHAPTER VI

HOSPITAL AND NURSING APPLIANCES

TJOSPITALS and nursing are so intimately
1 1 connected that it is impossible to study one
without the other. But from the very universality
of nursing, it is practically impossible to do more
than present important epochs or phases, lightened
by a fringe of personal detail ; and similarly the
extent of hospital history forbids more than
passing glimpses into romantic legends or special
features of a few among the endless array of
picturesque mediaeval foundations.

The most ancient hospitals in towns or villages,
says Toilet, were, with some few exceptions, small,
holding only from six or seven to fifty patients;
while those in large cities provided for, at the
most, from three to four hundred.

Many of the famous hospitals still in existence
had a very humble origin in some small alms-
house, home, or cloister. Not until the twelfth
century did hospital buildings begin to be planned
on anything approaching to the huge scale familiar
to-day.

The three most ancient of the still great and

233

234 A History of Nursing

celebrated hospital foundations are those of the
Hotel-Dieu in Lyons, the Hotel-Dieu of Paris,
and the Santo Spirito in Rome. The stories of
the two former include important leaves in nursing
history and will be related separately, for the
tales of these venerable homes of nursing sister-
hoods form a chapter in themselves.

A once famous hospital now devoted to other
purposes was founded in 580 A. D. by bishop Masona
in what is now called Merida in Spain. A descrip-
tion of it by a deacon named Paul is still extant.
Paul has at first related the good deeds of Masona
in building monasteries, and then he continues:
' Afterwards he built a hospital for strangers,
endowed it richly, and charged the doctors and
attendants to care for the needs of the sick and
the strangers with devoted zeal. He directed
that the doctors should continually go on tours
of investigation in the remotest quarters of the
city, and bring in their arms to the hospital any
one, whether bond or free, Christian or Jew, whom
they found to be ill. Such patients were to be
put immediately on litters or beds prepared in a
suitable manner, and delicate and nourishing food
was to be given them until the time when, God
willing, they were restored to health. And no
matter in what abundance supplies were brought
in to the hospital from its farms, still they seemed
to this good man only half enough, and adding to
these good deeds even greater ones, he instructed
the doctors to set aside half of every donation-

Hospital and Nursing Appliances 235

every bequest made to the shrines and churches,
-and to bestow it on the sick." ! In commenting
on the use of the word "doctor" in this quotation
from Paul the deacon, Haeser remarks that the
terms "servitors,' 'doctors," and ' priests " were
evidently used synonymously for one and the same
men, whose duties were in all probability similar
to those of the parabolani.2

The Santo Spirito in Rome, now standing on
the bank of the Tiber, dates its existence from
Ina, king of the western Saxons, who after his
abdication lived in Rome, and founded about
717 A.D. a church with a small guest-house for
pilgrims of his own nationality. It was dedi-
cated to Mary, and the Saxon relationship is
commemorated in its full title ' Santa Maria in
Sassia' (Saxon y). King Offa of Mercia enlarged
the guest-house in 794, and the income to support
it and to provide care for the sick was derived
from certain properties in Britain.3 Twice, in
817 and 847, it was burned down and rebuilt. In
1077 it was devastated by Henri IV. and in 1162
by Frederick Barbarossa. In 1198 it was rebuilt
by Innocent III., on a form and plan which con-
stituted the beginning of its modern history.

1 Bin Beitrag zur dltesten Geschichte der Krankenhauser im
Occidente. C. F. Heusinger in Janus; Zeitschrift der Gescli.
der ]\Iedizin, Breslau, 1846, pp. 772—773.

2 Op. cit., pp. 38-40.

3 Der Hospitaliter Or den vovn he Hi gen Geist. Virchow,
Ges. Abhandl. aus detn Gebiete der offentliche Medizin, Berlin,
part P., 1879, p. 27.

236 A History of Nursing

It is usually cited as the earliest instance of a
hospital in the modern sense ; that is to say, among
those now existing it was the first to emerge de-
finitely from the xenodochium or almshouse
pattern to the specialty of receiving only the sick.
Yet even this statement requires some modifi-
cation, for the Santo Spirito held from Innocent
a special commission to care for abandoned
infants. Haeser dates the history of modern
hospitals from the time of this rebuilding of
Santo Spirito.1 Between 1471 and 1484 Sixtus
IV. again rebuilt it, as it was falling to pieces, and,
except for certain interior improvements and
embellishments, it has stood from that day to this
unaltered.

A collection of exquisite old engravings, dating
from the fifteenth century and unearthed from
the archives of the hospital at Dijon,2 tells the
story of the hospital's foundation with all the
childlike simplicity of legend based on the trage-
dies of daily life. It is said that Innocent was
impelled to the establishment of the hospital
by seeing, one day, the corpse of an infant dragged
up from the Tiber in a fisherman's net, and the
various details of this story are pictured in the
engravings. Thus in one scene three guilty young

1 Op. cit., p. 24.

^Histoire de la Fondation des hopitaux du Saint Esprit de
Rome et de Dijon, M. G. Peignot, 1833. To be seen in the
Surgeon-General's Library, Washington. From this the
material for the text has chiefly been taker

rf
I

Architectural Detail
From the Ospedale Maggiore in Milan

Hospital and Nursing Appliances 237

women are shown, standing upon the bridge, with
Rome's seven hills and many towers in the back-
ground. They are casting their swaddled bam-
binos into the stream. As a matter of history,
infanticide wras at that time horribly frequent,
though some people like to believe that it has
been a custom restricted to 'the heathen."

In the next picture we see the Pope, who is in
bed, ill. In the foreground two physicians seated
on low stools are consulting, while in the back-
ground a third, wearing a large cap and ermine
cape, is examining a specimen in a glass jar.
Hovering near the bed is an angel, who whispers
the story of the drowned babes in the Pope's ear,
and bids him order the Tiber to be dragged. The
next picture shows the Pope relating his vision
to the cardinals, who give the order, and in the
background a serving wroman is despatching two
fishermen, who start off with alacrity.

Then the fishermen are seen dragging their
nets and bringing them up weighted with pitiful
little corpses. They bring them in and display
them before the eyes of the horrified Pope.

An angel now brings the Pope a revelation
showing where the hospital is to stand, and gives
him a miraculous sign by which he will know the
spot. The stately cavalcade goes forth across
the bridge, the Pope riding a donkey, w^hich kneels
down when the chosen spot, the site of the guest-
house of Ina, is reached. The buildings arise as
if by magic, and again the angel brings a re vela-

238 A History of Nursing

tion of the insignia for the nursing order. The
nursing was entrusted to the Brothers of the
Holy Spirit, and in the last engraving the Pope
distributes the blue habit with the cross to the
kneeling Brothers.

A second set of engravings sho\vs the equally
miraculous origin of the Hospital of St. Esprit
at Dijon, actually founded by the Duke of Bour-
gogne in 1204, for this charitable duke, having
visited the Santo Spirito at Rome, was filled with
great zeal for a similar institution. Again the
spirited drawings tell the story and show the
duke being taken by the Pope to visit the Santo
Spirito in Rome. They make the round of the
wrards where the patients are lying in their beds.
The duke receives the papal permit, returns and
confers with his architects, bestowrs the vestments
on his monks of the nursing order, and trium-
phantly visits the completed and occupied hospital
with his duchess. Incidentally, the glimpses of
the wards are the prettiest possible.

These historic hospitals had architecturally
the style of the palaces of that day, still seen in
many palaces and reproduced in many hospitals
now in existence, namely, the long, solid, two-or-
three-story barracks built around open courts
or squares, and capable, owing to their pecul-
iar construction, of almost indefinite extension.
Striking examples of this style are represented
by the great general hospitals of Milan and of
Vienna, the former, a most exquisite example of

— '. — r_-3p!

\l V • /

_j ;?' »>a&;

»„,. -.-<m«i.^i..r •^FTjrTM-p-y.

-J^~-

Hospital and Nursing Appliances 239

Renaissance art, being a very beautiful, and the
latter a very ugly specimen. As a hospital plan
this copy of mediaeval palaces is now, on sanitary
grounds, of course, considered altogether bad.
Mediaeval hospitals naturally shared in the ar-
chitectural variations of age and country. French
hospitals built at the end of the twelfth century
were sumptuous and magnificent specimens of
Gothic art, looking like cathedrals, and with
wards suggesting glorious abbeys or church aisles,
while vast and luxurious gardens often sur-
rounded them, as at the abbey hospital at Laon.
A German historian describes a typical mediaeval
hospital as follows :

Walled off from the outer world, with artistically
wrought gates and magnificent towers, the mediaeval
hospital is erected in surroundings of garden and
terrace. It often resembles a fortified section of a
city, enclosing a church and palatial buildings, with
many courts opening one from another. The courts
are planted with shady trees and shrubbery. Foun-
tains rise flashing from the midst of carved bowls
and shells. Round about stretch the well-furnished
corridors, colonnades supporting the upper floors;
under these protecting roofs the sick wander on pave-
ments of many-coloured marbles. Corridors, stair-
cases, and the great reception room are ornamented
with life-size paintings and marble statues, in honour
of the benefactor of the place. Or here and there
are paintings shewing the consolations of religion:
The Raising of Lazarus; the Good Samaritan; the
Arising of the Daughter of Jairus; Healing of the

240 A History of Nursing

Lepers; the Resurrection. In the high-ceilinged
wards, whose walls are stately with their glazed
tiling, stand at one end the Altar and the Cross. At
the opposite end is a chimney; here and there are
marble carvings. The beds are hung with curtains;
between each two, sunk in the wall, is a marble wash-
basin. Above the whole hospital towers the church
building with a cross shining from its spire. Decor-
ated with Doric or Roman columns, the portal allows
visions of the interior with its multi-coloured twilight.
Rich in marbles, sculpture, and painting, splendid
with blooming flowers and candle-light, stands the
High Altar. Solemn and festal sound the periodical
clang of bells, the roll of the organ, the melodies of
mass and hymn in the quiet wards, and remind the
suffering ones of the prayers of the church for the
healing of mind or body.1

Italy kept the palatial style, or established
hospitals in cool, lofty-ceilinged cloisters sur-
rounding luxurious gardens, — well adapted to a
hot climate. In Spain later there were fine
examples of Spanish Renaissance, such as the
Santa Cruz of Toledo, now a military school.
The free cities of Flanders and North Germany
had in the thirteenth century very beautiful
hospital buildings, while in South Germany the
ancient hospital at Rothenburg, though of early
origin, affords another example of how much
beauty and picturesqueness could be lavished on

1 Allgem. Umrisse der Culturgeschichtlichen Entwickelungdes
Hospitalwesens und der Krankenpflege. Maximilian Schmidt,
Gotha, 1870, pp. 15-17.

a
a

4->

a
o

a
2

<*-!

t— i

Hospital and Nursing Appliances 241

a hospital and its appendages. As to works of
art found in old hospitals, they are innumerable.
Among the specimens of cloister hospital the
stately Ospedale Civile in Venice, 600 years ago
a Dominican monastery, is one of the most im-
posing and beautiful, while more picturesque
and characteristic monastery hospitals than those
of Naples could hardly be found. The Ospedale
Maggiore of Milan, just mentioned, in its present
form dates only from 1448, though Milan had
xenodochia in the fourth century, and a hospital
for foundlings in the eighth. The Ospedale was
originally a ducal palace and, with the permission
of the Pope, wras turned into a hospital by Fran-
cesco Sforza and his wife Bianca. It is supposed
that a number of the small establishments were
then merged into the general hospital. The city
of Florence is full of old hospitals of artistic and
historic interest. Santa Maria Nuova, exter-
nally of great architectural beauty, wras founded
in 1287 by the father of Dante's Beatrice, Folco
de' Portinari. It was originally a dwelling-
house holding twelve beds and the piety of his
servant old Mona Tessa, who spent her days in
nursing, gave, it is supposed, the impulse to Por-
tinari. The hospital where Romola went to nurse
her patients is still in existence, but is no longer
a hospital. It is now the Accademia dei Belli
Arti, and contains interesting pictures of early
hospital life, among others showing the medical
saints, Cosmos and Damian, setting a broken leg.

VOL. I. — 1 6.

242 A History of Nursing

Santa Maria was described in 1348 as being "full
of sick, both men and women, who are nursed
with much care," and a century later high praise
is again recorded of it, although it often happened
that two or three persons had to be put in one
bed. Nevertheless, the beds were kept white and
clean, the food and medicines were adapted to
every case, and 'watchers of the sick': were
ready to minister to every wrant. The manage-
ment was considered so admirable that the Pope
and the English king asked for copies of the
regulations. In 1650 single iron beds were intro-
duced, to the wonder and admiration of the
citizens. It is typical of the general deterioration
of the eighteenth century (to which we will revert
later) that in 1742 the condition of this interest-
ing old hospital was described as being horrible,
the food bad and insufficient, and the medical
attendance wretched, while corpses were buried
in the central courts, causing 'pestilential' ex-
halations.1 In Florence also is to be seen the
most unique and interesting foundling asylum in
the world, the Ospedale Santa Maria degli Inno-
centi. In its early history, one learns of the piti-
iful fate of abandoned children, who, in the dim
centuries of the beginning of our era, became the
property of the finders, were regarded as slaves,
and could be sold or hired at will by their masters.
To substitute a merciful for a merciless owner-

1 Old Florence and Modern Tuscany, by Janet Ross, 1904,
pp. 60-65.

Entrance to the Heilige-Geist Spital at Rothenburg on the Tauber. The hos-
pital was enclosed by the city walls in 1280

Hospital and Nursing Appliances 243

ship was the impulse that caused a good monk
of Milan to found there, in 787, the foundling
asylum which later gave the example to Florence.
The Innocenti was built under the patronage of
the guild of silk merchants in the early part of
the fifteenth century, being completed in 1451,
and is a model of lovely architecture, decorated
with fine paintings and adorned with the well-
known Luca della Robbia medallions. The little
foundlings were 'given their freedom' at the
age of seven ; that is, they were never to become
slaves. They were placed about with families
who promised to treat them as their own children,
taught trades, the girls dowried, when married,
by the hospital, or the foster-parents, or else fin-
ally placed in convents.

Cow's milk was used to nourish the foundlings
for the first time in 1577, some travelled duke
having reported seeing in Spain the wonderful
sight of a cow whose milk was given to children.
To-day this richly historic house is in the charge
of the Sisters of St. Vincent de Paul, under the
direction of a highly scientific and progressive
council chiefly consisting of medical men, and
is one of the most perfectly kept and well-managed
institutions of the kind in existence, its union
of mediaeval charm with modern science being
a congenial and happy one.

The old hospital of Santa Maria della Scala in
Siena, with its thousand years and more of his-
tory, is second to none in i^+erest. It was founded

244 A History of Nursing

in the ninth century by Soror (born 832, died 898),
a man of humble position, who after the manner
of the early Christians was wont to take pilgrims
and needy persons into his own frugal home for
hospitality. The gifts of gratitude and recognition
that came to him enabled him finally to build a
hospital on the present site opposite the Duomo.
Part of the new structure was composed of marble
taken from the steps of an ancient temple of
Minerva which had stood on the same site, and
from this it took the name ' della Scala." The
hospital received foundlings, reared, dowered, and
married them. It also entertained strangers,
gave alms to the poor, and nursed the sick. The
order of nursing Brothers that Soror established
here was, it is said, the earliest order of hospi-
tal Brothers under a regular rule.1 Beside the
Brothers, an order of Sisters was, of course, estab-
lished for the care of women and children.2 In
time the hospital became very wealthy, and on
account of its good management many others
affiliated with it. From the time of the com-
pletion of the Duomo, the hospital nurses were
canons of the cathedral. The names of St.
Catherine and San Bernardino, both of whom
nursed here, add to its fame. Catherine's work
has been mentioned. San Bernardino's greatest
nursing work was done here during the plague
of 1400. He is represented in paintings as

1 Wetzer u. Welte, Kirchenleocikon, art., "Hospital."

2 Haeser, op. cit., p. 28.

Hospital and Nursing Appliances 245

restoring the blind to sight, doubtless commemo-
rating his actual services in saving the eyesight
of patients afflicted with purulent disorders. The
large hall of Santa Maria is adorned with wonder-
ful frescoes, depicting the nursing duties of the
Brothers, and the dowering of the foundlings.
Another Italian hospital established by pious
men was that of Santa Maria Annunziata in
Naples, which was built in 1304 by two brothers,
Nicolas and Giacomo Scondito.

Every traveller who has crossed a mountain
pass into Italy and has been refreshed by the
monks of a hospice will realise what, to lonely
pedestrians centuries ago, must have been the
shelters which were erected in snowy passes and
wild places along the footpaths of the traveller
to offer him hospitality, warmth, and food. One
of the most famous of these hospices was that
founded by the Vicomte of Flanders at Albrac
or Aubrac, France, on a snow-covered pass, in
gratitude for his escape from robbers. Its resi-
dents included priests; two knights-at-arms to
escort and protect the pilgrims, one to go before
and chase away robbers ; clerical and lay Brothers
to serve the hospice, one to wait on the poor,
servants and farm hands, and five Sisters of
quality with maids to show hospitality to women
travellers.1 In the twelfth century there were
numerous communities of this character, some
of the oldest being at Cologne, Mainz, St. Goar,

'Helyot, iii., p. 169.

246 A History of Nursing

Ntirnberg, and Wiirzburg. In the twelfth cen-
tury, too, in the cities, every institution had its
creche, so named from the French, who from the
fifth century put out cradles at the doors of hos-
pitals and churches to receive the foundlings.

But not alone could Christian lands boast of
numerous and beautiful hospitals in the early
centuries of our era. The Saracens possessed
hospitals as beautiful, and, for a time, far surpass-
ing those of Europe in medical science and as
schools of learning. Heusinger mentions records
of hospitals and xenodochia in Cashmir about
the time of Christ, and says that these were named
after the royal charitable women who endowed
them.1 Macrizi mentions an Arabian hospital
founded by one of the caliphs in Cairo as early
as 707 A.D., where lepers were isolated and the
blind cared for; and again one built by another
caliph in 85 4- 8 55.2 Only freemen and civilians
were treated in this hospital. No slaves or sol-
diers were received. On entrance the patients'
clothing and money were taken from them and
kept until their departure, the hospital providing
their garments.

According to medical historians, the opposition
of the clergy to the study of natural sciences lay
at the root of a ' brilliant and romantic pil-

1 Das Alter der Hospitaler in Cashmir. Janus, Breslau,
1847, II., PP- 393-394-

2 Beschreibung der Hospitaler in El Cahira. Janus, 18465
I., pp. 28, 39. Translated by Wiistenfeld.

Alinari, photog.

The Care of the Sick
A fresco in Santa Maria della Scala, Siena

Hospital and Nursing Appliances 247

grimage" made by the scientific medical spirit
to the East, from which it returned with the
Saracenic invasion by way of Spain. The story-
is delightfully told by Dr. Fossel,1 who goes back
to the heresy of the Nestorians and their wander-
ings early in the fifth century into Persia, India,
and China, where they carried a spirit of inquiry
and investigation :

Welcomed in Mesopotamia, Syria, and Persia, they
carried with them the science of Greece and founded
centres of learning in which Christians, Jews, and
pagans alike shared. Medicine became the first study
in importance, and Greek science now came in contact
with the rich experience of the physicians of India.
There were medical schools with hospitals for study
and practical experience in many places, that of
Dschondisapor (a modern province of Persia) being
the most famous.

The Arabs carried hence the sacred embers of
learning, and took them into all the lands they
conquered, endowing old hospitals and building
new ones. One of these famous hospitals was
built by the mother of a caliph in 981. It had
twenty-four physicians appointed to it, and abun-
dant service of nurses or " bed-makers, " and at-
tendants. The patients were received in special
wards or divisions according to their maladies.
But the most magnificent of the many Moham-

i Offentliche KrankenpfLege im Mittelalter, Dr. Victor Fossel,
Mitth. der Ver. der Arzte in Steiermark, 37 Jahrgang; no. 3,
PP- 37. 58.

248 A History of Nursing

medan hospitals was in Cairo, built in 1283
the Sultan El Mansur Gilavun. It was endowed
by him for ' ' the great and the lowly ; for free and
for slaves; for men and women." There were
separate wrards for fevers, alternating with open
courts and large shady gardens ; wards for surgical
cases, for eye troubles, for the insane, and for
convalescents. Every ward had a spring of
water running through it to keep the air cool.
There were large halls for clinics and lectures,
where the physicians taught their classes, and
special rooms for the preparation of drugs and
remedies, and for all kinds of supplies. The
nursing was done by 'bed-makers" -men and
women — and not only were patients treated in the
hospital, but free medical and nursing care, with
medicines and nourishment, were also supplied
to the poor of the city in their homes, and dis-
charged patients were given a gold piece, that
they need not return at once to work. This fa-
mous hospital is mentioned by many writers.
Another very fine one was at Damascus. It was
said that no one was refused in these hospitals
and that the time of stay was most hospitably
extended. A story runs that a Persian gentle-
man, visiting Damascus and seeing the hospital,
concluded he would enjoy staying there for a
while; so pretending to be ill he was admitted.
The physician, recognising his case, ordered him
any diet he liked, and for three days he lived on
the fat of the land. Then the physician wrote

Hospital and Nursing Appliances 249

him a ' prescription ' in which it was intimated
that visitors should not stay more than three
days, and he was discharged cured.1

In all large cities, such as Alexandria, Damas-
cus, Bagdad, Merv, Ispahan, and others where Ara-
bian culture was supreme, splendid hospitals were
erected with schools for the practical teaching of
medical students. The Arabs also founded many
institutions in Spain. Cordova alone, in its
glorious prime, had fifteen hospitals. The fame
of these medical schools drew patients and stu-
dents alike from every land in Europe, and when
finally with the fall of the Saracenic power fell
also these centres of culture and of medical study,
'the torch of knowledge, which they had kept
burning for centuries, was passed on from the
hands of the Mohammedans to illuminate the
foundation-laying of the medical schools next
to be built by Western nations." 2

Closely associated with the development of
medical science in Central Europe was the famous
old hospital of St. Barbara, in Strassburg, in the
twelfth century, which later was united with a
second, called the Hospital of the Poor Strangers
and now known as the Burgerspital.3

It is not to be supposed, however, that hospi-
tals in general shared the sanitary and luxurious
features of those of special fame. Although the

1 Withington, Hist. Med., p. 165.

- Fossel, op. cit.

3 Virchow, Geschichte des Aussatzes u der Spitdler, p. 313.

250 A History of Nursing

wards built in wealthy abbeys and surrounded
by gardens were models of comfort and cleanly
propriety, many of the poorer hospitals in the
towns were crowded and unwholesome, as may
be judged to-day by the relics of the thirteenth and
fourteenth centuries in small towns which have
undergone but little transformation. Even before
the growing hospitals attained their later vast size
the dangers and unsanitary conditions resulting
from the crowding together of so many patients
were recognised and emphasised by the nurses
of the Middle Ages. In 1250 the Master and
Brothers of the Augustinian nursing order in the
Katherine hospital at Regensburg issued a report
in which they complained that their narrow
quarters were not only not sufficient for the re-
ception of the needy sick, but that they became
infected, and that as a consequence the patients
were exposed to contagion and died before their
time, on account of the poor construction, the
foul air, the poisonous exhalations and contagions
of the too closely crowded sick.1

The gradual evolution of the appliances and
conveniences which count for so much in the
care of the sick has been traced by Dr. Paul Jacob-
sohn in his very interesting series of papers on
the history of nursing appliances,2 and in a large

1 Schafer, op. cit., ii., 135.

2Beitrdge zur Geschichte des Krankencomforts. Deutsche
Krankenpflege Zeitung, iSg8. In four parts beginning pp. 141;
153; 170; 255.

Hospital and Nursing Appliances 251

and exhaustive treatise, in which he describes
the various phases of the sick-room idea in all ages.
While certain necessary appliances, such as enema
bulbs and catheters, night lamps, basins, bowls,
and vessels of various kinds have been made and
used from the most remote antiquity, yet on the
whole, up to the eighteenth century, articles and
conveniences used for the sick had been almost
entirely such as were capable of being adapted
to that purpose from the conveniences or utensils
of the healthy. They had all been adapted to
the use of the sick, and belonged almost entirely
to what he calls "improvised technique.'' Thus,
in the mediaeval hospitals the comforts and fur-
nishings used for the sick were the same as those
in ordinary use. The eighteenth century saw a
general deterioration in nursing and hospital organ-
isation, and, naturally, the surroundings of the
sick were also changed for the worse. The large,
airy halls, the cool springs and fountains, and
the sweet green gardens of the mediaeval hos-
pitals of France, Spain, and the East now gave
place to the small dark wards of the city and state
institutions of the eighteenth century. One au-
thor mentions the clumsy wooden beds with their
thin curtains; the heavy wooden shutters to
keep out the sun; the wooden floors sprinkled
with vinegar and water to lay the dust and cool
the air. Much esteemed were all kinds of smok-
ings and burnings to purify the air: orange and
lemon peel, dried apples, sugar, and various

252 A History of Nursing

pungent drugs and woods. Spirits of lavender
were also used, mixed with vinegar and shaken on
a hot shovel, or rose water with vinegar and lemon
peel heated in a pan over hot coals or an alcohol
flame. The causes of bad air are only too plainly
shown in the absence of ventilation and in a
primitive system of dealing with utensils; and
Dr. May, who was very enlightened, recommended
the use of a thermometer, and also advised that
all utensils after being used should be carried at
once out of the ward. Articles made of rubber
were then unknown. Draw -sheets, pillows, and
rings were covered with leather (as they had
probably been throughout the whole Middle Ages) ;
the two latter being stuffed with moss, horse-
hair, or feathers. Such a thing as an irrigator
was not in existence. For cold feet there were
the stone jugs filled with hot water in place of
the long-handled brass bed-warmer, filled with
live coals, of the Middle Ages. As to poultices,
their variety was nothing less than astonishing.
Dr. Pfahler's book, written twenty-five years
after Dr. May's, shows a great advance in comforts
and conveniences for the sick room. { Drinking
cups in his day were made of porcelain or glass
instead of tin, and silver or ivory spoons replaced
those of tin or pewter. Urine-receivers were
made of glass and cleansed with ashes and salt.

1 According to Dr. Jacobsohn, Dr. Pfahler utilised French
sources for his book. See page 534, Vol. 1.

Hospital and Nursing Appliances 25

Now appeared the first invented modification of
the bed — a jointed arrangement like a steamer
chair being devised, with a reading desk to be
attached to it. About this time too the use of
hair mattresses became known; air-cushions came
into use, and an oiled cloth for draw-sheets was
manufactured ; bed curtains were made of green
instead of figured chintz. Dr. Pfahler recom-
mends green branches, and crushed ice in bowls
to freshen the air, and water poured from one
pitcher into another to induce sleep by its sooth-
ing sound. He would have the patients washed
before eating, and describes the feeding cup and
long tube. He also gives better directions for
treating bedsores, and orders cushions covered
with deer skin and soft cloths. The old fashion
of enclosing the beds with curtains or alcoves
was thought to give the patient an agreeable
privacy, and this was an advantage — outweighed,
however, by the bad air of the enclosed space.
In 1777 portable bed-screens were invented by
Le Roy, but they were clumsy, and it was con-
sidered so impracticable to carry them about that
they \vere not used. As, however, the alcoves
remained, advanced writers, unable to endure
the bad ventilation of the wrards, advocated a
single room for every patient. In the old Munich
hospital the alcoves were finally removed as late
as in 1832, partly to get rid of bedbugs and partly
because they did not permit of clinical teaching.
In 1774 Anton Petit, of Paris, wrote a book on

254 A History of Nursing

the best methods of hospital construction.
Dr. Anselm Martin's book written in 1832 l gives
excellent directions for the personal care of the
patient — "his nightcap not too tight; neckerchief
dry and warm; cleanliness of body, the patient to
be washed and combed ; his eyes, nose, and tongue
carefully cleansed." To avoid mistakes with
drugs external and internal powders were to be
put up in papers of different colours. This use
of colours is seen to-day in the Italian hospitals,
where wrappers of many colours are used for
powders, each having its significance. Medicine
droppers did not exist at that time and the
directions given for dropping accurately from
the bottle are astonishingly minute and lengthy.
Bladders filled with cracked ice or snow are now
mentioned, and many different kinds of baths.
To bathe the eyes, the patient must sit up, holding
a basin, in the centre of which is a glass filled
to overflowing with thu appropriate solution,
The patient leans over and holds his eye in the
glass, opening and shutting it that the fluid may
bathe the eyeball.

In the Charite of Berlin, in 1832, central heating
was coming into vogue and corridors and bath-
rooms were warmed. Many points of hospital
construction were now better, notably the windows

and shades. For night duty, large lamps were
not recommended, and a little wax light floating

1 Die Kunst, den Kranken zu pftegen, Munich, 1832.

Hospital and Nursing Appliances 255

in a basin of water was invented. Meals were
served with more daintiness. A napkin or towel
was to be spread on the patient's bed and over
this a tray. For bed patients to eat their meals
from a table beside the bed was found most in-
convenient. Underclothes were not to be worn
in bed, and separate sleeves, tied on at the
shoulder with tapes, were recommended for
certain cases. Iron bedsteads now appeared,
but they were not liked. True, they were at
first very clumsy and unwieldy, and were only
tolerated because less likely to harbour vermin.
Dr. Dieffenbach described scathingly the rubbish
and trash that careless nurses allowed to accumu-
late on the old-fashioned beds with their testers-
" old shoes, apples, soap, spiders, mice nests and
bedbugs ; while the worm-eaten wood harbours
ticks. Under the beds are coals, potatoes," etc.
Air cushions and rings were invented about
1830, but the patients did not like them as well
as the old spinal rings filled with horse-hair (no
doubt because they were distended too tightly).
About this time, too, tin or lead cans of different
shapes were made as bed- warmers. After this
period, says Jacobsohn, a reactionary stage of
dulness again fell upon hospital construction and
fittings. The physicians, absorbed in purely
scientific work, ignored alike nursing and hospital
appliances, and no further advance was made
until the influence of Kaiserswerth and the work
and writings of Miss Nightingale made themselves

256 A History of Nursing

felt, when hospitals rapidly assumed a cheerful
and comfortable character, which the English
hospitals pre-eminently have always displayed.
The discovery of the germ theory brought the
attention of medical men to the interior of hos-
pitals, and two pronounced results followed:
first, everything septic was banished, and secondly,
a conscious effort was made to furnish aseptic
articles specially adapted for the use and con-
venience of the sick. The extreme cult of asepsis
for a time brought back the bare and cold appear-
ance of hospital wards, and in quite modern times
it has been largely due to the efforts of Prof. C.
V. Ley den and M. Mendelssohn in 1890 that the
conception of the therapeutic value of cheerful
and agreeable interiors of wards has been dis-
seminated in Germany and the countries which
look to Germany for teaching. As a result this
hitherto neglected branch of treatment is being
considered seriously to-day, with the result that
hospital wards, while still aseptic, are becoming
more attractive and pleasant to the occupants.1

» Transcribed from Jacobsohn, op. cit.

CHAPTER VII

RISE OF THE SECULAR ORDERS: THE BEGUINES.
SANTO SPIRITO. OBLATES OF FLORENCE

Benedictine monasteries, having reached
I the height of their vigour and influence some
five hundred years after their foundation, entered
upon a long, slow period of decadence, which,
while retarded here and there by favourable circum-
stances, was generally marked by formalism, loss
of primitive zeal, and even, in some places, by the
lapse of moral standards. In so far, at least, as
the nursing orders are concerned, a new kind of
monasticism sprang into being toward the twelfth
century, which has been called the golden age of
monasticism, as it was also the golden age of
chivalry. The twelfth and thirteenth centuries
were marked by an irrepressible energy that
found expression in voluntary association outside
of the older and more stereotyped church orders.
Of such free and spontaneous character were some
of the most notable and successful nursing associa-
tions, for in that brilliant, chivalric, devout, but
often cruel and superstitious age, nursing con-
tinued to present itself as a form of service ap-

257

VOL. I. — I?.

258 A History of Nursing

pealing most readily to the imagination and heart.
Tuker and Malleson speak of the ''moral miracle'
that 'took place in the uprising of women all
over the world, forming themselves, at their
own initiative, into congregations of workers —
the ' active orders. ' ' 1 By far the greatest number
of nursing orders from now on arose not within,
but without the Church, as lay or secular societies.
It is true that, in comparison with what are now
called secular associations, these mediaeval ones
would seem to us even in their freest initial stages
as strictly, even severely churchly, so wholly was
religious ceremonial and observance a part of
daily life. But to be 'religious' then meant to
take solemn or perpetual vows, and the secular
orders limited themselves to obligations of chas-
tity, obedience, and sometimes of poverty, while
even these vows were not perpetual. As time
went on, however, all these orders in turn came
more or less under the control of the clergy.
Haeser says : :

We see these pious nursing orders originally develop
entirely independently of the Church. Most fully
is this the case when they are connected with institu-
tions of secular origin. But none of these associations
escapes, in its final development, the influence of the
Church, under which (as is most frequently the case)
they either willingly place themselves, or by which,
if they show signs of resistance, they are of purpose

1 Vol. iii., p. 250.

2 Of. cit.,p. 37.

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Rise of Secular Orders 259

controlled. That such attempts at resistance were
not lacking is shown by repeated injunctions of the
Church asserting its right to organise all, even lay
associations, and by continuous efforts of lay orders
to maintain a line beyond which the church power
should not advance.

It is of interest to note that something in the
very nature of nursing service naturally eludes
strict monastic forms and is resistant to solemn
vows. Thus the great nursing orders of the Mid-
dle Ages were steady, if not always conspicuous,
correctives of the tendency toward rigid monas-
ticism and brought a continuous counter-current to
bear upon it. HOWT much this essential character-
istic of nursing as an occupation — the refusal to
be bound by other than its own requirements-
had to do with first delaying, and then overcoming,
enclosure, or, from a more general point of view
just how great a factor it has been in the move-
ment of women toward economic equality, is a
subject that has not as yet received as much
attention as it deserves.

Foremost as a woman's movement of this
secular character, and, according to Helyot,1 the
earliest of the secular communities, was the order
of the Beguines of Flanders, one of the most
dramatic and determined of the many groups of
workers which, in the pursuit of free and useful
activity, continually formed and reformed, creating
fresh organisations as the older ones became fossil-

1 Les Ordres Monastiques, vol. viii., chap, i, p. 8.

260 A History of Nursing

ised and ineffective. The order of the Beguines
represented several related principles. It was a
protest against evils which were creeping into
the more artificial monastic life of the time ; against
formalism and useless repression ; and an assertion
of a high moral standard coexistent with the
right of initiative and of spontaneous self-ex-
pression in work. Haeser says : l

Many associations, among them the Beguines, can
only be properly estimated by regarding them as re-
formatory efforts toward greater freedom, and it is
not only by chance that several such developed and
reached a high point in Belgium, for in that country
a free life of the people has always been vigorously
asserted.

The date of the origin of the Beguines has been
much disputed, and all critical writers on the
subject devote much space to the discussion of
errors and misstatements. We have adopted
Hallman,2 and those other German historians who
are in agreement with him, as our main authority.

The writers of the seventeenth century, says
Hallman, show great confusion in regard to the
Beguines. Some trace their origin to St. Begga,
in the seventh century, and others do them in-
justice in identifying them with a sect at Vil-
vorde of somewhat notorious character. They
have also been called canonesses, while again it is

1 Op. cit., p. 46.

2 Die Geschichte des Ursprungs der belgischen Beghinen.
Dr. E. Hallman, Berlin, 1854. Also Haeser, op. cit.

Rise of Secular Orders 261

stated that their observances were opposed to
canonical life. It appears to be definite that St.
Begga, the daughter of the Duke of Brabant,
was not the founder of the Beguines. Some
historians say that she founded a convent of
strict rule in 685, while others say she established
the order of canonesses of Audenne. It seems
reasonable to suppose, as another authority sug-
gests,1 that the Beguines may have chosen Begga
as a patron saint, independently of any other
relation.

Lambert le Begue, a priest of Liege, an ardent
reformer of a deeply religious nature, who fear-
lessly attacked wrongs entrenched in high places,
and did not hesitate to denounce the clergy them-
selves, is the central figure of the first group of
women called Beguines. He is called the founder
of the order, and if we venture to suggest that
the dissatisfaction with existing conditions and
the plans to arrange a different mode of life for
themselves first arose in the minds of women of
character and judgment, being communicated
by them to Lambert and by him shaped and sup-
ported, we can only advance this as a conjecture.
Whoever first conceived the plan, it was Lambert
who with fiery eloquence pictured the evils which
had crept into the double monasteries, and, de-
claring that it was possible to live a pious life

1 Wetzer und Welte, Kirchenlexikon, art., " Beghinen und
Begharden."

262 A History of Nursing

and do good works outside of strict church rule,
urged the formation of a community where women
could live God-fearing lives separate from men.
To him also the women owed the first endowment
which enabled them to organise, for Lambert
was possessed of wealth, which he devoted wholly
to the purchase of a tract of land and the erection
of buildings where this novel theory could be
tested. The pattern on which the community
was established may be seen to-day, to the great
interest of visitors, in the Beguinages of Bruges
and Ghent. In the centre of a large tract of
land or meadow stood the church, which Lambert
dedicated to St. Christopher on the 26th of March,
1184 A.D., on its completion. Scattered about it
were numbers of tiny single houses, each stand-
ing alone and accommodating from two to four
people. The whole settlement was surrounded
by a wall. As seen to-day, the most exquisite
neatness and order characterise the establish-
ments of the Beguines, and the rows of little
houses on the green plain, overtopped by tall
trees and centring about the church of simple
architecture, have a singular expression of peace
and serenity. The next Beguinage was built at
Tirlemont in 1202, and that of Ghent in 1234-5.
After this the example spread rapidly through-
out Belgium and the neighbouring countries. The
earliest were built outside of the walls of the
cities, but after these had suffered damage in
war times the later ones were put within the city

Beguine cTAnvers
Helyot, Les Ordres Monastiques, etc., vol. iii., p. i

Rise of Secular Orders 263

walls. (The one within the city of Bruges was
built in the thirteenth century.)

The life of the Beguines was partly in the world
and partly conventual. Instead of the strict
rule of the convent they had only simple regula-
tions. They vow^ed themselves to chastity and
obedience for the time they were in residence.
'I ... promise you, my father, and the au-
thorities present and future, obedience and chastity
while I remain in the Beguinage." But they were
free to leave at any time, and free to marry.
They did not obligate themselves to poverty, but
retained their own property. Certain ones were
allowed to live with their relations in the town.
These, however, were not eligible for all the bene-
fits of the commune. Nor did all the communities
wear the same dress, for at different times and in
different places we find habits varying in colour
and style. In Liege the dress was usually grey,
in other places blue, and in Nimes and Nivelle it
was the ordinary dress of the world. The special
feature of these communities was the little houses
where two, three, or four lived together and did
their own housekeeping. This plan must have
been suggested to Lambert by some woman, for
he would surely not have thought of it himself.
The members were recruited from every class of
society. The only fixed requirement for their
plan of living was extreme simplicity; different
regulations marked different communities. Thus
in Malines the Sisters were not allowed to keep

264 A History of Nursing

little dogs without paying a tax to the church.
The well-to-do members lived at their own ex-
pense, and often left bequests to the community.
Those without means did some kind of work,
such as lace-making, an industry still followed
in the Beguinages, or sewing; some of them went
out as nurses; others, then as now, taught children
and young girls. The old and feeble members
were cared for at the cost of the community, and
were not allowed to become objects of public
charity. As the community acquired wealth,
this was expended, first, in houses for the use of
members without means of their own; secondly,
in a hospital; and thirdly, in a church. The
hospital was regarded as the most important part
of their communal property, and Haeser says
that the existence of an old hospital building
anywhere was often the reason for beginning a
new Beguinage. From the pay patients in the
hospital, from those in private nursing, and from
the proceeds of their industries they derived an
income which they regarded as a common fund
and used for costs and repairs, for general ex-
penses, charity to the poor, improvements to
the grounds, the building of bridges, and
other purposes. Not every Beguinage owned a
church; and when this was lacking the Sisters
attended the parish church. But as soon as their
resources permitted a church was built. The
regulations of the Beguines were not submitted
to the Pope for approval, but were agreed upon

Rise of Secular Orders 265

by the Superioress and her assistants, and by the
bishop of the diocese.1 Though the parish priest
was accorded a nominal headship he had no real
authority, but consulted with the elder Sisters.

For his criticism of the Church Lambert was
tried and imprisoned, and finally went to Rome,
to plead his cause in person with the Pope, where
he died. Fifty years after Lambert's death there
were 1500 Sisters in the order. They spread into
Germany, Switzerland, and France, where they
were protected by Louis the Pious, who estab-
lished a large community in 1264. During the
thirteenth and fourteenth centuries every small
town in France, Flanders, and Germany had
its Beguinage. These often began on a very
small scale, perhaps with only three or four
Sisters, but increased with extraordinary rapidity.
Frankfort had 5 7 ; Strassburg about 60 ; Cologne
had some 140 Beguinages, each one domiciling
from 100 to 700 members. An old writer counted
5000 Beguinages, and, in the beginning of the
fourteenth century, the whole number of women
thus grouped was reckoned at 200,000. The
dwellings of the German Beguines were known
by various names — Klausen, Seelhauser, Gottes-
hauser. The women were known as Poor Children,
Voluntary Poor, Lullist Sisters, Capucines, Blue
Nuns. In the fifteenth century the name Beguine
often excited a prejudice in Germany (for there

1 Helyot, vol. viii., chap. i.

266 A History of Nursing

the Sisters had from time to time shown hysteri-
cal or undignified tendencies, or, as sometimes in
France, had overstepped the bounds of propriety
in their lives). For this reason the name 'Seel-
schwestern" was adopted. There were many
points of similarity between the Beguines and
the Tertiaries of St. Francis and St. Dominic
and there was often close associatian between
them. Thus the German Beguine houses often
chose Franciscan or Dominican priests. As time
• went on, many communities became Tertiaries
of either St. Francis or St. Dominic. The Belgian
Beguines were always more dignified than those
elsewhere, net hysterical, in nowise disposed to
mendicancy, and always more independent.

By the beginning of the fourteenth century
the industrial and economic features of the Be-
guinages had become even more pronounced. A
great number of dependents were maintained,
and the communities took on the characteristics
of poorhouses of a superior sort. The following
quotations are from regulations passed in the
year 1325: 'Each Beguine shall be obedient
to her pastor in all rightful things, and come at
least three times a year to confess and commune.
Each Beguine hospital shall have a Superioress
who shall give permission to go out. No Be-
guine shall saunter about the streets without
supervision, or sing indecent songs. After the
evening bell no Beguine shall sit at the door on the
street or go out except for the most necessary

Rise of Secular Orders 267

causes. Persons of the male sex over ten years
of age shall not remain in the houses of the Be-
guines, nor shall any strange woman live among
them. If a Beguine is to be punished, all the
Sisters must appear on the ringing of a special
bell. No one who has been disciplined is per-
mitted to complain to her relatives over the
affair." These rules wrere in force until 1467.

The Beguines, on account of their striking
innovations in community life and their assertion
of autonomy, met with clerical opposition and
even with a certain amount of persecution. Hel-
yot describes some of the errors into which they
fell, as for instance that "it was not necessary to
fast, or to submit to directions, or to obey mortal
men." They were accused of heresy, and were
classed with the Waldenses and other free-thinking
sects. The opposition went so far that in 1215
an order of the Pope forbade the founding of any
more such sisterhoods. Despite all opposition,
however, the people upheld them, the civil au-
thorities protected them, and it was impossible
to stay the movement. Though they at times
suffered more or less persecution, sometimes being
driven from their houses, they eventually re-
turned to them. In 1311 at the Council of Vienna
their orders were again designated as heretical :
nevertheless, they flourished and extended, being
protected by the princes of the country and
even by the bishops. That there were free
thinkers among them is evident. Thus in 1310

268 A History of Nursing

a Beguine, Margareta Poreta by name, wrote a
pantheistic book. It is evident, however, that
the practical usefulness of their lives was un-
deniable, and justified the protection of commune
and prince. The freedom of the Beguines, so
intimately bound up in the Belgian character,
is thus described by Bishop Malderus of Antwerp
in 1630:

The Order of the Beguines is truly not a religious
order, but a pious society, and compared with the
former complete consecration is as a preparatory
school in which the piously inclined women of Bel-
gium live after a pattern highly characteristic of the
temper of mind and the character of the people. For
this people is jealous of its liberty and will be led
rather than driven. Although it is. beyond a doubt
more meritorious to devote one's self to the service
of heaven by vows of perpetual chastity, obedience,
and poverty, and though there are many pious
women in Belgium who are so disposed, yet most of
them shrink from this irrevocable vow. They prefer
to remain inviolably chaste rather than to promise
to be so; they are willing to obey, but without for-
mally binding themselves to obedience; to rather
use their poverty in reasonable outlays for the poor
than to give it at once up for good to all ; rather
voluntarily renounce daily the world than immure
themselves once and forever.

Throughout the whole time of the active career
of the Beguines, nursing remained an important
branch of their work. One of their most beautiful

' •>>
^

u-
U

"B, .5
o «

a I

Rise of Secular Orders 269

settlements was at Malines, where there were over
1500 Sisters, not including their dependents. This
would appear to have been a nursing centre of
importance, for Helyot says that the nursing in
many hospitals was provided for by orders arising
from the Beguines of Malines. Two especially
noted and very beautiful hospitals were those
at Beaune (this hospital remains almost in its
former beauty to-day) and Chalon-sur-Saone.
The former was founded by Nicolas Rolin, chan-
cellor of the Duke of Burgundy, in 1443, and he
brought Beguines from Malines to take charge of
it. It was built with much magnificence, with
long wards extending into a chapel, so that the
sick could hear the services, and opening into
square courts with galleries above and below.
Patients of both sexes and of all ranks and
degrees were received, both rich and poor. There
was one ward for those most seriously ill, and
back of all a building for the dead, with 'many
lavatories and stone tables." In the upper
galleries were suites of apartments for wealthy
patients, and the gentlefolk came from leagues
around. The suites consisted of a bedroom, dress-
ing room, anteroom, and cabinet. They were
richly furnished, and each patient had three
beds, that he might move from one to another.
Each apartment had its own linen, utensils, and
furniture, "and borrowed nothing from any
other." The suites and wards were named after
the King, royal family, dukes of Burgundy, and

270 A^ History of Nursing

other prominent personages. In the middle wards
patients of the middle class were received, and
in the lower galleries the poor. The rich patients
had their own food and wine sent to them, and
paid for their medicines, but the rooms and the
Sisters' services were free. Few, however, left
without bestowing a gift. The poor were cared
for without any cost, but if they wanted anything
special they had to buy it. A little river ran
through the court and was carried in canals past
the different departments for drainage. It was
noted that the hospital had no bad odours, such as
were found in so many others, but was sweet and
clean.1

The hospital at Chalon-sur-Saone was also
very magnificent, and there, too, there were no
bad odours, but in winter delicate perfumes and
in summer baskets of growing plants hung from
the ceiling. It had a large garden, with a stream
running through it, with little bridges over it.
Helyot mentions also the beautiful drug rooms
in these hospitals where the Sisters did the dis-
pensing; also the dormitories,- and the dining
halls for the Sisters. The buildings were sur-
rounded with extensive gardens and trees, and
had an ample water supply. The sick were
nursed there," he wrote, "with all the skill, re-
finement, and sweetness that might be expected
from the appearance of the place." The B6-
guines who established this work founded a

1 Helyot, vol. viii., chap. i.

Rise of Secular Orders 271

distinctly hospital nursing order, and the Sisters
of St. Martha of Burgundy, as they were called,
remained active in hospital work.

Various causes combined to effect a gradual
diminution in the numbers and size of the Be-
guine communities. With the changes of the
Reformation they lost their German communities
and the buildings were taken for poorhouses.
In Halberstadt an example of this kind is still to
be seen. Elsewhere they passed into the hands
of the Church, as at Steenort near Vilvorde, where
they were given over to the Carmelites in 1468.
They are now principally confined to Belgium,
where the most important groups are those at
Ghent — the Great and the Little Beguinages-
and that at Bruges. Here the Beguines have
retained a corporate existence to the present day,
and constitute at present as historically interesting
a community of women as can anywhere be found.
The freedom and independence of their original
mode of existence, their self-supporting charac-
ter, the irreproachable dignity and quiet, simple
usefulness of their lives, continue unchanged.
They have passed through vicissitudes and perils,
but always safely. As early as the thirteenth
century on the occasion of the conquest by Phil-
lippe le Bel they were in great danger of being
sacked, but, sending a deputation to the monarch
to beg for protection, they were accorded a gra-
cious reception and ample safeguarding. At the
time of the French Revolution they lost some of

272 A History of Nursing

their lands, and were ordered to lay aside their
distinguishing dress. However, the comparative
freedom of their rules, and the support accorded
to them by popular esteem, preserved them from
serious injury, and the mandate regarding their
habit was ignored. In 1824 they were defended
against the attempted aggressions of William
of Holland, who was disposed to abolish their
rights, by the action of the municipality of Ghent,
who in a petition set forth their great services
in time of war, epidemic, or disaster, and their
blameless, useful lives, with such success that the
King's unfriendly purposes were changed. In
1809-10 the Beguines of Belgium had devoted
their whole strength to the service of the army
during an epidemic of fever. During the war
of 1813 their buildings were turned into hospitals,
and after Waterloo they literally gave all they
had to relieve the overwhelming distress. In
1832, 1849, and 1853 they again served nobly
in cholera epidemics. Beside their readiness as
nurses they have likewise not been wanting as
good citizens. In 1821 they contributed a gener-
ous sum toward the establishment of municipal
industrial workshops, and have often acted as an
aid society in dispensing contributions to sufferers
from natural disasters, such as inundations and
fires. In 1869 a sympathetic and admiring vis-
itor chronicled their numbers and conditions.
There were then about 800 members in the Great,
and 300 in the Little Beguinage. In the com-

Hospitaliere de Ste. Marthe
Helyot, Les Ordres Monastiques, etc., vol. viii., p. 7

Rise of Secular Orders 273

munity at Bruges, which is somewhat exclusive
and almost entirely composed of women of the
higher classes, there were about thirty. There
were in all, at that date, twenty-one groups, some
few of which were in Holland. They were uni-
versally respected, and lived frugal, industrious
lives under their Superioress or Grande Dame, even
the wealthy ones sharing in manual work. Beside
teaching, managing creches, nursing, and pre-
paring the dead for burial, they carried on a
number of self-supporting industries of a skilled
character and domestic purpose.1

The Beghards, a men's order similar to that of
the Beguines, whose first members at least were
weavers, appear to have taken no part in nursing.
The Beghards were throughout turbulent and
much more distinctly heretical than the Beguines.
Their order arose later than the women's, and
soon disappeared. By the fourteenth century
the name Beghard was synonymous with that
of every conceivable kind of heretic.

A little later than the establishment of Be-
guines appeared other groupings of women of
similar characteristics, the products of that same
sturdy deep-rooted love of liberty which, united
with a strong religious sentiment, marks those
people whose free cities erected the majestic bel-
fry as a symbol of civic independence. The Sis-
terhood of the Common Life, one of these orders

1 All of the igth century details from The Beggynhof, by the
author of Gheel.

VOL. I. 1 8.

274 A History of Nursing

gathered about Gerhard Groot, of De venter,
born in 1340, an idealist and leader of thought.
He also founded the Brothers of the Common
Life, in whose community Thomas a Kempis
lived and studied.1 Like the Beguines, the Sisters
took no vows and entered into no binding con-
tracts. Ihey wore a simple grey dress, and sup-
ported themselves by their work, but unlike the
Beguines they returned to a conventual form of
living under one roof, and holding no private
property. Everything was held in common and
there was one common purse. Their special vir-
tues were obedience to those in authority, humility
that found no duty too lowly, and friendliness to
all. They were preeminently visiting nusres.
A secular nursing order of great distinction

o o

and for a long time of great activity in hospital
work was that of the Santo Spirito or Holy Ghost.
Certain old historians, claiming a great antiquity
for this order, have attempted to trace its origin
back to the days of Alary and Martha and to the
numerous charitable houses that they are sup-
posed to have founded. Vague legends are told
of a nursing order working in these houses and of a
military fraternity to protect the pilgrims, their
patients. Father Helyot disputes the historical
accuracy of these claims,2 yet it is quite possible

1 Thomas a Kempis and the Brothers of the Common Life, by
Kettlewell, London, 1885.

2 Histoire des Ordres Monastiques, etc., vol. ii., chap. xx>:.
pp. 195-198.

Rise of Secular Orders 275

that a continuity in nursing systems existed in
fact though records be imperfect. Roubaud and
Toilet give the year 1070 A.D. as that of the origin
of the order, l but all other writers begin its history
with Guy de Montpellier, of whom, indeed, little
is known save that he was of knightly class, lived
in Montpellier in the latter part of the twelfth
century, and established there about 1180, upon
a former and much older foundation, a hospital
and a nursing fraternity called 'the Brotherhood
of the Santo Spirito. The statement sometimes
made, that the Brotherhood was founded in 1198,
really means that in that year a bull of Innocent
III. mentions the Hospital Santo Spirito in Mont-
pellier, seven others in France, and two in Rome.2

The order has also been called a knightly one,
and this is corroborated by Helyot, who holds
that at some period in its history it was a knightly,
though never a military order ; for, he says, there
is no proof that the chevaliers of this order ever
bore arms or went to the crusades.3

The order of the Santo Spirito in its original
form was a secular brotherhood, and its chief dis-
tinction and importance in nursing history lay
in its early and close association with general
hospitals in towns and cities. Heretofore the

• Hist, des H 6 pitaux, Gazette des Hopitaux, Paris, 1850, p. 598.
Felix Roubaud. Les Edifices Hospitalers, Paris, C. Toilet.

2 Hist. Devel. of Modern Nursing, Jacobi, Pop. Sci. Monthly,
Oct. 1883

3 Vol. ii., chap, xxx, pp. 195-206.

276 A History of Nursing

great increase in the number of hospitals had
been mainly in the form of pest-houses or shelters
outside of the walls, for patients whose infectious
disorders caused them to be expelled from towns,
and where the nursing was carried on by some one
of the orders founded especially for the care of
lepers and allied diseases, but the order of the
Holy Ghost from its earliest days was identified
with the rise and development of general hospitals
within city walls.1

This movement was synchronous with the
rise of the middle class in its struggle for education
and admission to the learned professions, and
with the gradually increasing disposition of civil
authorities — as cities became powerful and au-
tonomous— to take over the control of hospital
revenues and management.

Thus the secular brotherhood both influenced
and in turn was influenced by the gradual progress
of medical science, which, from now on, rested
largely on experience gained in the hospitals
within the wTalls of cities. As regards the general
plan of its nursing system, the order was among
those owing an indebtedness to the Knights Hos-
pitallers of St. John, for it adopted almost word
for word the code of the latter relating to internal
management. Women were also admitted to
the order as nurses, but historians have almost

1 Der Hospitaliter Orden vom heil. Geist, Virchow, in the
Ges. Abhandl. a. d. Geb. d. off, Med., Berlin, 1879. II, pp.
23-108.

Religieuse Hospitaliere de 1'Ordre du St. Esprit dans ie Comte de Hourgogne,

en habit ordinaire dans la maison

Helyot, Les Ordres Monastiques, etc.

Rise of Secular Orders 277

completely ignored their existence. Dr. Hamil-
ton1 alludes to a widow Ernesseus who, in 1301,
devoted her wealth and gave her services to the
hospital in Montpellier, and Herzog mentions
with vague praise the diligence of the Sisters,
but how far they shared in the comparative
intelligence of the nursing system we cannot tell.
In 1204 the Pope called Guy to Rome to take
charge of the nursing in the hospital Santo Spirito.
The order of the Holy Ghost spread widely and
rapidly in Germany and over the Swiss borders.
Hardly a town was found within these borders
which had not its Hospital of the Holy Ghost,
and Virchow mentions by name over one hundred
and fifty, without assuming to have collected
complete records. The order long retained its
secular character of vigorous citizenship, though
an edict issued by Pope Gregory X., in 1271-76,
subjecting all the houses of the order to the one
in Rome was the first step toward destruction
of the secular organisation. In Italy and France
little by little it came more and more under
direct priestly control, until in those countries
it eventually became strictly monasti c . 2 Germany
and Switzerland resisted this tendency long, but
in 1446 the order was put tinder the Augustinian
rule, and the duties of canonical office, singing
in choir, etc., were added to those of nursing, of
course to the detriment of the latter. In the

1 Thesis, p. 23.

2 Helyot, vol. ii., chap, xxx; p. 206.

278 A History of Nursing

seventeenth century the order had so degenerated
that Louis XIV. tried (though without success)
to abolish it in France. It clung persistently to
its great possessions ir> Europe and the West
Indies and retained them up to the eighteenth
century. A remnant of this order still may be
found nursing in some of the Italian hospitals.1

The habit of the Brothers, at least in France
and Italy, was originally sky-blue with a black
mantle ornamented with a double-armed white
cross. This garb was altered later, and the blue
robe was worn only in choir.

The hospitals of Florence have long been distin-
guished as having a nursing service greatly su-
perior to that of the majority of Italian hospitals.
With the exception of two or three special institu-
tions— one for men only, another a maternity,
and another the famous Innocenti, which is not
strictly speaking a hospital — all the Florentine
hospitals are under the nursing care of a secular
order of women, of great antiquity and historical
interest, — the Suore ospedaliere Figlie di Maria
Madre della Misericordia, whose ancient title
was simply ' le oblate ' or ' le Donne Oblate rli
Santa Maria Nuova."

We have already mentioned the origin of Santa
Maria Nuova, and this order of oblates seems to
have grown into existence almost contemporane-
ously with the hospital itself. An Italian historian,

5 Jacobi, op. cit.

Chanoine Regulier et Hospitalier de 1'Ordre du St. Esprit, en habit de Chceur,

en Italic

Helyot, Les Ordres Monastiques, etc.

Rise of Secular Orders 279

Marco Covoni, gives the date as 1296. Only fri-
ars are at first mentioned as officially employed,
but the humble Mona Tessa, who devoted herself
to the sick here, and induced other pious women
to share the work, may have been overlooked.
Documents prove that Tancia was the name of
the foundress of the order, but it is possible that
Mona Tessa and Tancia were one and the same
person. The order was increased according to
the needs of the hospital, and has continued to
supply nurses to each new hospital as it has been
erected. In olden times the ;' oblate' vowed
themselves for life but are now free to leave at
the end of three years' vows. They are under a
Mother Prioress, who is elected every three
years and is eligible for indefinite re-election.
The Prioress was at first chosen by the :'com-
missario" of the hospital, who was then invari-
ably a priest, and afterwards formally elected by
the Sisters; the principle of secular control was,
however, adopted in 1782, when lawyers or sena-
tors became eligible to the office of ;<commissa-
rio.'' In 1850 physicians were added as eligible,
and from 1873 a mixed council of seven lay direc-
tors has ruled the hospitals and the nursing serv-
ice. The Mother Prioress is now elected by the
Sisters after nomination by the council.

The convent of the order stands opposite to
Santa Maria Nuova, and is connected with it by
an underground corridor. The sisters wrear a
woollen robe, but with a more practical veil than

280 A History of Nursing

many others. Like those of other orders, their
nursing duties are quite restricted, consisting
chiefly of giving medicines and food, supervising,
and directing the housekeeping, while the chief
burden of the nursing work is borne by the servant
nurses; however, the secular management has
taught them more science than usually falls to
the lot of religious nursing Sisters, so that this
ancient order, possessing a continuous history of
hospital service next in length to that of the Sisters
of the Hotel-Dieu of Lyons and of Paris, is still
vigorous and successful in adapting itself to a
changing environment.1

1 We are indebted to Miss Amy Turton, who for many years
has been in close touch with hospital work in Florence and
Rome, for the material relating to the oblates of Florence.

CHAPTER VIII

THE NURSING SYSTEMS OF TWO FAMOUS HOSPI-
TALS OF PARIS AND LYONS

Hotel-Dieu of Lyons. — Of all mediaeval hospitals,
those of which we possess the most complete re-
cords dealing with the nursing arrangements are
the Hotel-Dieu of Lyons and that of Paris. The
name Hotel-Dieu — God's house, — especially in the
early mediaeval period, was generally used to
designate the principal hospital in a French town
or city. These Houses of God were originally
xenodochia or almshouses, receiving the needy,
the infirm, and the sick of every kind and class.

In the year 542, at the request of Sacerdos, the
archbishop of Lyons, Childebert I., the son of
Clovis, with his wife, Ultrogotha, founded the
Hotel-Dieu of Lyons, which later became one of
the largest and most complete of all the hospitals
of France.1

It was designed to shelter pilgrims, orphans,

1 The material relating to the hospital of Lyons has been
taken entirely from the Histoire topographique et medicate
du Grand Hotel- Dieu de Lyon. J. P. Pointe, Paris and Lyons,
1842.

281

282 A History of Nursing

the poor, the infirm, and the sick. The first small
buildings were soon outgrown by the urgent
needs, the demands upon the institution being all
the greater because in an extensive territory it was
the only one into which soldiers could be received.
As a consequence a number of dependencies or
branch hospitals were erected — separate from but
belonging to the parent building — and in these
were accommodated the contagious cases and those
of other special classes.

Childebert appointed physicians for the wards
from among the members of an academy which
then existed in Lyons. Later a Royal College of
Medicine succeeded the academy and inherited
its hospital service. From the first the Hotel-Dieu
of Lyons presented a striking contrast to other
institutions of the time in its comparative freedom
from clerical control. Its administration was at
the outset confided to the laity, a very unusual
thing at that time in hospital systems. For six
hundred years it remained under lay management.
In 1192 wre find a religious order of Citeaux in
charge, but just wrhen this change was made is
not clear. This order ruled it for several hundred
years, but in 1478 there wrere complaints that the
monks had abandoned their responsibilities to
"counsellors and aldermen." The mayor of
the city urged putting the hospital in charge
of a board whose members could give their whole
time to it, and in 1583 the Brothers yielded the
government to a new body of laymen called " Rec-

Nursing Systems of Two Hospitals 283

tors.'' Under their management the hospital has
prospered and developed as it could never have
done so long as it remained only one of a group of
varied interests.

From 1308 until the present time the Hotel -
Dieu has been a wealthy corporation. It is
interesting, as showing ho\v much alike are the
methods of the people of different centuries,
to note that in 1641 theatrical performances were
given for the benefit of the hospital.

The nurses of the Hotel-Dieu also are quite
unique as regards their organisation and original
standing. The earliest archives allude to them as
"servantes chambrieres, ' : ' filles repenties, ' ! ' peni-
tentes' and in actual fact the staff of women
nurses and servants was taken largely from
among fallen women who had repented and wished
to lead a better life. They were taken into the
hospital — many of them, no doubt, being first
admitted as patients, — and devoted themselves
to its service. Beside the penitents, however,
widows sometimes entered the nursing service.
As time went on the nurses were called 'quasi-
religieuses," and since the end of the seventeenth
century they have been known as Sisters. The
men of the nursing staff, originally called serv-
ants, were later termed Brothers.

At first no special uniform was worn, but in
1526, because the latitude allowed in matters of
dress had resulted in costumes being worn which
were a "cause of scandal" the Rectors decreed a

284 A History of Nursing

uniform white garb. In 1562 this was changed to
black with a white linen apron and an unstarched
white cap. The chief motive for the adoption
of a uniform was the need of propriety outside of
the hospital, for the nurses wTere often sent out to
do private nursing, and to take part in the cere-
monies at funerals.

In the middle of the sixteenth century, the
Rectors adopted rules calculated to meet the
spirit of the times, and which, no doubt, were
intended to put the nursing service on a more
dignified plane. For this reason they introduced
more stringent regulations, certain changes of
uniform, and a religious ceremonial. Application
for entrance now had to be made six months in
advance, and one year's probation under a Mother
Superior was required. If the applicant was
approved by the Mother Superior at the
end of the year's trial she received a grey
garb with a collar around the neck. If she
continued to be satisfactory she was later ac-
corded a formal ceremony of dedication. Friends
and outsiders were invited, high-mass was cele-
brated in the church, there was a sermon on works
of charity, and the nurse took a vow at the altar
to discharge her voluntarily assumed duties with
fidelity. The aspirant was draped in a large
mantle of black cloth ; she was veiled with a white
veil, and wras presented with a silver cross. The
ceremony was made in every way as impressive
as possible. Nevertheless the nurses were not

Nursing Systems of Two Hospitals 285

allowed to regard themselves as "Sisters'1 in
the sense of nuns, but were still held definitely
accountable to their secular authorities. This is
made very evident by a little incident which oc-
curred in 1611 as the result of a gradually in-
creasing tendency to a strictly conventual rule
of life on the part of some of the nurses. A wave
of religious excitement had passed through the
ranks, and culminated in a demand made by a
certain Louise Soyr, who, at the very moment
of sharing in the ceremony above described, pub-
licly declared her desire to take solemn vows
and demanded the veil from the hands of the
clergy. No doubt Louise had been encouraged and
incited to this step by some of her companions,
who meant, if she were successful, to make a
similar request. But the Rectors refused her
demand with emphasis, and took the occasion to
make the positive statement that the Hotel-
Dieu was not a convent but a hospital ; that there
were to be no nuns there, but only wTomen volun-
tarily called to serve the sick poor; that these
women could receive their uniform only at the
hands of the Rectors, and that, as they were free
at any time to leave, they were also at all times
liable to dismissal. No more was heard of solemn
vows, and the Rectors continued as before to
hold the reins. The Brothers' dress at this time
was a blue robe, and on feast-days they wore a
silver badge with the hospital arms on it. The
moral effect of a uniform was well understood

286 A History of Nursing

in the Hotel-Dieu. The physicians, when making
their rounds, always wore robes with flowing
draperies and caps, and the Rectors also wore a
grave and serious dress when they visited the
hospital.

The worthy old Rectors tried various experi-
ments in order to perfect the discipline among
the nurses. Their authority of necessity was
delegated to some one person at the head of the
nursing staff, sometimes the steward, sometimes
the Mother Superior, sometimes the almoner or
secretary. The steward might be a monk or a
layman, but in either case the final authority
and supervision rested with the Rectors. At some
time during the sixteenth century the Rectors came
to a conclusion which reflects great credit on their
common-sense and sound judgment. Realising
that there were many details into which the
steward could not enter with the women nurses,
and which, nevertheless, it was his duty not to
ignore, they saw that this practical handicap pre-
vented him from being informed of all that went
on. They, therefore, chose a woman possessing
skill and intelligence, whose whole function it
was to direct the nurses and servants and appor-
tion, supervise, and be responsible for their work.
The holder of this office was successively called
Mere, Mere Maitresse, Gouvernante, and Superi-
eure. Her responsibilities were great. She car-
ried a key to the archives, presided at receptions,
and had the privilege of appearing before the

Nursing Systems of Two Hospitals 287

Rectors in their meetings, to report upon the
moral and material conditions of the house. Thus
in 1586 the "Gouvernante" appeared at the council
of Rectors to complain that many dead bodies of
patients had been buried at the expense of the
hospital, but that no compensation had been re-
ceived from their heirs. Again, in 1606, the "Mere
Maitresse' having recently died, we are told
that the Rectors had to increase the number of
their meetings in order to deal with the numerous
matters that had been unattended to since her
death.

It was not often that a nurse left voluntarily,
unless it was to marry or to take care of some
near relative. In 1597, we are told, one went
home to care for her aged mother after twenty-
three years of service in the wards.

The number of nurses in the early days seems
to have been entirely inadequate. In 1335 two
Sisters and three servants were considered enough.
In 1523 a Mother Superior and sixteen Sisters
formed the staff of women. The famous old hos-
pital must have been very small in its beginning,
or the branch establishments are not counted
in ; or the patients must have done a goodly share
of the work. In 1598 the hospital had only one
hundred beds. Actually, however, its capacity
was considerable, for each bed was capable of
accommodating five patients. The lay Rectors
seem to have had not a few good practical ideas
about nursing. In 1630 they decided that in

A History of Nursing

future every patient should have a bed to him-
self, and shortly thereafter all the old wide beds
\\ere banished forever. On the whole, in general
internal management, in the eareful separation of
cases, and the isolation of contagious diseases,
in the provision for night duty ^an older Sister
always tx near, to direct the younger ones).
and in the actual serviee to the siek by the Sis-
U rs, the liotel-Dieu of Lyons in the Middle Ages

.: show a very ereditable reeord — incomparably
>r to that of Paris, and probably better

.ai that of most hospitals of that tune.

The eighteenth eenturv.a time of general deterio-

Q j * o

.. n in nursing, saw some falling off in the hospital

For a long p. . steward was

almost constantly a priest. esid< the spiritual

the staff of nurses, their temporal

and discipline v in his hands. The

" Mere Superieure." who had presided with such

ity, had disappeared, but when and why she

was eliminated Pointe does not explain. In i;>5

the Rectors again asserted themselves and ordered

that the double authority held by the steward

should no longer re main in one pair of hands.

O i

The sre wardship was he: : to a

the priest reserved only his authority
in spiritual matters, while the lay steward as-
sumed disciplinary powers in the w.

When the >:^rm of the Revolution broke, all
the religions rders were banished. The ch\

the Sisters of the Hotel-Dieu, which had lu-

Nursing Systems of Two Hospitals 289

ally been becoming more nun-like, was replaced
by the simple garb of the ordinary citizen and
adorned with a tricolor. But in 1802 the priestly
power flourished once more in the hospitals and
then began a period of active struggle and clashing
between the clerical and secular heads. As has
happened always since the world began, the two
warring elements sought to gain control over the
women, and the nursing department was the
storm centre. To introduce a more rigid convent-
ual order was the purpose of one; to prevent it,
of the other. The fierceness of the strife caused
the public and the nurses themselves to take
sides in the fray. The administration was de-
termined to retain the right to place and replace
the nurses in their wards, to regulate their go-
ings-out and comings-in. So determined was the
resistance made by the clerical party to these
to us so simple and proper demands, that the
contest ended by the ' Maitre spirituel ' leaving
the hospital with forty loyal Sisters, who had
fought under his banner. It was a victory, but at
a heavy price, for the hospital, which suffered
for some time from the rawness of a new and
inexperienced staff. The seceding Sisters formed
a community, adopted a religious monastic dress,
and have since that time been active in private
nursing. Their order is called the " Bon Secours."
In 1840, the affairs of the hospital having settled
down into a regular routine, the strong and weak
points of the nursing system are thus summed up

VOL. I. — 19.

290 A History of Nursing

by Pointe, who concludes with certain criticisms
and suggestions. , The hospital then contained
noo beds. The Brothers and Sisters were chosen
from a respectable artisan class, those being
selected who wTere of upright character, strong
and healthy, and possessing some little education,
at least the ability to read and write. They were
accepted between the ages of sixteen and twenty-
five years, and, after being examined as to morals
by the priest, were admitted on probation by the
lay steward. During the probationary period
of some months they wore their own civil dress;
but after being proved satisfactory they were
given uniforms and the titles " sceur pretendante '
or 'frere pretendant,' for final admission to
the order was only made as death or some other
cause created a vacancy among the full Sisters
or Brothers. The candidate might thus have to
wait ten or more years before being finally
consecrated.

When the final ceremony occurred they were
given a cross, and from this they were termed the
1'croise'es." They were then entitled to life-long
support from the hospital, and received a small
allowance. The distribution of the nurses in the
wards was regulated by the steward, who was
thus practically the head of the service. The
wards were presided over by head nurses- " chef-
taines' -and the assistant nurses were in the
proportion of one to ten if medical, or fifteen
to twenty if surgical, patients. The nurses were

Nursing Systems of Two Hospitals 291

supposed to perform all duties relating to the
care of the patient and there were domestics for
the housework of the wards. The night duty
was apparently not as well organised as in the
Middle Ages, for there was only one young Sister
for every hundred patients, and no older night
Sister in charge. The best feature was the
"cheftaine," who had learned every detail of her
work by long experience, but the weak points
were that the administration changed the nurses
too often ; that the servants were rough ; the Sisters
were not always well disciplined, and were often
insubordinate to the physicians. Pointe con-
sidered that either the latter should have full
control over the nurses in all that pertained to
the care of the sick, or that, if this interfered
with the unity necessary for the administration,
then at least the criticisms and complaints of the
physicians should receive more attention. In
point of fact, they were ignored.

Further, he thought that the Brothers should
be replaced to a great extent by Sisters, as it was
impossible to secure a desirable class of men as
nurses. Finally, he considered that it would be
advantageous for the service to re-establish the
" Mere Superieure," and far better for the nurses,
who needed the advice, protection, and super-
vision of a woman, but who were left entirely to
the management of men. It is so unusual to
find a suggestion of this nature voluntarily made
by a man in discussing hospital service, that

292 A History of Nursing

M. Pointe deserves honourable mention for his lib-
erality of view. Dr. Anna Hamilton gives the
latest picture of the Lyons Sisters in a report
on nursing in France.1 They are given an ele-
mentary professional education in the hospital,
are fairly well disciplined, and are free to leave
the service and to marry. If they choose to re-
main, they are certain of a support, as mentioned.
But, free and liberal as their constitution is, they
receive no real training in the modern sense and
their wrork is behind the times and crude.

The Hotel -Dieu of Paris, which has been for
centuries past and to-day is still one of the
famous hospitals of the world, dates from 650
or 651 A.D. A small and modest hostel with some
slight provision for the care of sick people, tucked
under the protecting shadows of the church of
St. Christopher and bearing its name, was the
humble origin of the present vast hospital with
its hundreds of patients. To Bishop Landry of
Paris, whose statue now stands in the entrance
to one of the blocks, is ascribed the impulse which
brought it into existence. In connection with it
was a small nunnery, occupied by a group of
charitable women who had volunteered their
services to the church to embroider altar cloths
and see to the decorations. Later this community
of St. Christopher extended its aid in service to the
little house of charity. But little is known of

1 Third International Congress of Nurses, Buffalo, 1901,
Transactions, p. 420.

Nursing Systems of Two Hospitals 293

the earliest time, and definite records only begin
in the twelfth century. In the time of Philippe
Auguste, 1164-1225, the hospital was moved to
the banks of the Seine near Notre Dame, the
palace of the bishop, and the cloisters of the canons
of the cathedral. The canons had been governors
of the hospital from 1097, and it was now entirely
rebuilt after the gloomy solid fashion of royal
palaces, and named Domus Dei, Hotel-Dieu.1

The kings of France soon made it the favourite
recipient of their benefactions. The ward dedi-
cated to St. Denis was the gift of Philippe Auguste
in 1195, and that of St. Thomas was built by
Blanche, mother of Louis the Pious. The hos-
pital domain was frequently enlarged. In 1788,
when it was described by Tenon,2 it embraced the
hospital by the Seine, the hospitals of St. Louis
for contagious diseases, that of St. Anne, a con-
valescent hospital for women and girls, a country
home for the Sisters, a farm, extensive store-
houses and granaries, and the Bureau or Adminis-
tration building.

Lepers were early excluded from the hospital,
if indeed they were ever received at all. From
ancient times Paris had had three leper refuges
outside of the city, and in 789 Charlemagne had
passed a decree forbidding lepers to mingle with

1 The chief authority drawn upon for the first part of the
chapter is U Hotel-Dieu et les Scetirs Augustines de 650 A.D.
a 1810, by Alexis Chevalier. H. Champion, Paris, 1901.

2 Memoir es stir les hopitau-x de Paris.

294 A History of Nursing

other people. The leper hospitals were separate
until 1693, when, leprosy having practically disap-
peared from France, they were affiliated with
other institutions and used for general pur-
poses.

No other ancient hospital has bequeathed to
posterity a nursing history so extensive or one
that has thrown so much light on internal hos-
pital management. For the publication of these
interesting records we have mainly to thank the
unremitting and bitter contest which for centuries
was carried on by the clerical and civil powers
over the administration of the important and
extensive institution. In this, as in every similar
contest, the nursing service was the chief storm
centre, and to gain control of the nursing staff
the main point of vantage sought. The story of
this struggle points anew to the elemental im-
portance of the nursing factor in the composition
of hospitals, and many useful lessons may be
taken therefrom.

The voluntary group of women who had first
decorated the altars and served the patients of
St. Christopher were collected and united in a
strict order by Pope Innocent IV., who would not
permit any self-governing religious societies of
women. He imposed regulations following the
Rule of St. Augustine upon them, and they were
thenceforth known as the Augustinian Sisters
or "Congregation hospitalieres de 1'Hotel-Dieu.'
Theirs is the oldest purely nursing order of nuns

Religieuse Hospitaliere de 1'Hotel-Dieu de Paris, en habit ordinaire servant

les malades
Helyot, Les Ordres Monastiqties^ etc., vol. iii., p. 186.

Nursing Systems of Two Hospitals 205

in existence.1 They had a rigid rule. In con-
tradistinction to the system upon which the
nursing Sisters of Lyons were established, the
Augustinian Sisters of the Paris hospital were
strictly monastic. They were subordinated and
entirely responsible to the clergy, and to all prac-
tical purposes and intents were almost the same
as cloistered nuns.2

Their entire lives were spent in the hospital,
and, once professed, they renounced the world and
all thought of any other home than its precincts,
or any other existence than that in the wards.
Even going out was hardly thought of, unless
they were sent to do private nursing. As novices
or probationers they passed through three stages :
at first they were probationers ("filles en appro-
bation") ; next they were accorded the white robe
("filles blanches"), and finally received the hood
("filles a chaperon"). The time of this probation
was seldom less than twelve years, but was often
even longer ; for, as the statutes fixed the number
of full Sisters, it was only when death removed the
elders that the novices were advanced to fill the
vacant places.

In comparison with the continuity of this an-
cient nursing order all others seem ephemeral.

1 Hamilton and Regnault, Les Gardes Malades, p. 12.

2 Le Grand says that, while the religious hospitallers of the
Middle Ages lived according to the Rule of St. Augustine, this
does not mean that all communities had of necessity the
same statutes throughout. Each group with separate govern-

296 A History of Nursing

'For twelve hundred years," says Dr. Bourn e-
ville, 'they have been so intimately associated
with the hospital that they have had no other
life. They have no other dwelling. Their home
is the Hotel- Dieu. From the day of their pro-
fession they live and die there."

There is something thrilling and pathetic in
the thought of these twelve unbroken centuries
of nursing of the Augustinian Sisters, and of their
successive generations, toiling, in complete self-
abnegation and renunciation even through their old
age, often to die in harness like poor old worn out
patient horses. And from the thirteenth century
on, at least, if not before, their lot seems to have
been made needlessly bare and hard. Not only
was their work almost cruelly heavy, but they
were denied that light of knowledge and of under-
standing which does so much to brighten the sever-
est toil. They were cut off from all share in the
intellectual life, and even the course of outer
human progress was closed to them. For them
professional instruction did not exist. Only a
routine handed down from one to another ap-
proached anything that could be called teaching. 1
What wonder that in time they atrophied ment-
ally and became incapable of progress; that

ment had its own local Constitution, with the Letter of St.
Augustine as a sort of prologue at the head. — Statuts d'Hotels-
Dieu el des Leproseries; Alphonse Picard et Fils, publ. by
L£on Le Grand, Paris, 1901. Introduction.
1 Hamilton, Thesis, p. 31.

Nursing Systems of Two Hospitals 297

science left them behind and that a changed en-
vironment found them unable to adapt themselves
to it? It may be that, had these women possessed
the love of liberty and the firm determination of
the Beguines, they could have withstood success-
fully the overweening claims of an authority w hich
was satisfied with nothing less than complete sub-
jection. But the blame for their ultimate deterio-
ration cannot fairly rest with them, but must revert
back to the authors and executives of the con-
stitution which was imposed upon them.

In 121 2 the bishops in council passed statutes
relating to the French hospitals, which contained
regulations for the nursing orders. Heretofore
each hospital had been a law unto itself, but now
an attempt was made to bring about a certain
unity, and the bishops decreed that all nursing
orders should take the vows of poverty, chastity,
and obedience, and wear a religious garb.1 In
this same council (which was a fateful one for
the calling of the nurse) the bishops decreed that,
in order to economise the gifts of the charitable,
just as few7 nursing Sisters as possible should be
maintained in each hospital.

This meant, of course, the maximum burden of
toil laid upon the shoulders of the nurses. Thus
ancient and eminent is the ancestry of the policy
of economising in institutions by limiting the
assistants and heaping on the work in the women's

1 Le Grand, op. oil.

298 A History of Nursing

departments — a, naive and simple expedient which
has not entirely disappeared from modern in-
stitutions. The bishops laid down definite rules
for the hierarchy of officials and for all the daily
round of the Brothers and Sisters: the hours for
rising and retiring; the number of meals and the
kind of food ; the clothing to be worn ; their com-
ings-in and goings-out ; the punishments for var-
ious and sundry offences ; all were shaped in detail.
The general management of the hospital was
placed in the hands of the Chapter of Notre Dame,
who delegated to this task two of their number
called "Proviseurs." These proviseurs — or, as they
might be called to-day, governors — placed in di-
rect charge, as superintendent of the hospital, one
chosen from the order of Brothers, who then
received the title of "Maitre."

The number of Brothers appointed for the
hospital was thirty, and this number was not
exceeded. Article thirty of the statutes provided
that the two governors and the superintendent
were to choose a Sister, who in their judgment
seemed most capable and worthy of the distinc-
tion, to command the Sisters, direct them in the
nursing, and maintain discipline among them.
This Sister, at first called the 'Maitresse" later
became known as the 'Prieure." The number
of full Sisters, which had been originally fixed
at twenty-five, was increased to forty, with an
addition of forty novices, because they not only
had the entire care of the female wards, including

Ancien Religieux Hospitaller de 1'Hotel-Dieu de Paris

Helyot, Les Ordres Monastiques^ etc., vol. iii., p. 184

Nursing Systems of Two Hospitals 299

all heavy work as well as the nursing, but also
served in the laundry and household departments.

No Sister or Brother was permitted to go
into the town, alone or with companions of his
or her own choosing, but only with some one
selected by the superintendent. They had two
meals a day, and meat three times a week. Their
food was frugal and the dishes were of tin or
pewter. The two refectories (one for the Sisters
and one for the Brothers) had long, yellow-painted
tables covered writh cloths. At one end of the
room, slightly raised, was the table of the Master
or Prioress. During meals one of the Brothers or
Sisters read selections from religious \vorks aloud.

The Sisters came in two relays to their meals
and one, called the Convent Sister, was in charge
of the meals and dining-room. Once a week the
Brothers and Sisters met together to hear and
to make complaints. Upon these un pi easing oc-
casions sentences for the ill -doings reported were
pronounced by the superiors. The punishments
were varied — deprivation of an already scant
diet, eating on the floor, or various acts of peni-
tence were imposed. Even corporal punishment
was sometimes inflicted, and, if a Brother was
to receive chastisement, he received it before all
the Brothers: if a Sister, she was punished be-
fore all the Sisters.1 So quaint and primitive
were the disciplinary methods of our ancestors in

1 Le Grand, op, cit.. pp., 43-53.

300 A History of Nursing

nursing. The Brothers and Sisters rose at 5 A.M.
Their ablutions finished, they went to chapel,
while the matron made rounds. After matins
they all went to their wards, put out the lamps,
and prepared for the duties of the day under the
supervision of the ' chef taines ' : or head Sisters.
One by one the patients wakened, and the wards
became animated. With basin and towel in
hand the Sisters went from one to another, washing
faces and hands, giving drinks, comforting, and
assisting generally. Then the beds were made.
Those who could sit up got out of bed. Those
seriously ill were lifted to the next cot. Meals
were served at n A.M. and 6 P.M. The porrin-
gers and spoons were of \vood. The patients had
meat four days in the wreek. Mutton was usually
employed for soups and stews. Beef, veal, and
pork were seldom used. There were soups,
eggs, fruits, cheeses, and tarts. On fast-days the
diet was principally herrings, pickled or in oil,
and onions preserved in nut oil. It sounds odd
to hear that each ward had three 'pintes' of
milk a week; a supply curiously in contrast to
the lavish consumption of milk in modern hos-
pitals, even though this 'pinte' equalled an
English quart. The very ill patients had a bet-
ter wine than the others, also chicken, squab,
gosling, and other delicacies. On fish days they
had small fried fish.

After dinner visitors were admitted to the
wards, and this time of partial leisure was occu-

From Les Edtfces Hospitallers, C. Toilet, 1892. Hamelin Freres, Montpellier

Nursing Systems of Two Hospitals 301

pied in the many details which could not be
attended to in the busy morning. There is a
pretty picture, too, of the festivities and cele-
brations on saints' days, when the patients' beds
were decked with garlands of flowers and when
something of the general gaiety brightened the
dull wards. The night Sisters came on duty at
seven. They had an allowance of wine to drink
at night, but no mention of food is to be found.
Once or oftener during the night the Prioress
made the rounds of the wards. Each full Sister
had her own room. The novices slept in a
dormitory.

Next to the superintendent the Prioress held
the most important position, and to a certain
extent she was independent of him and could go
direct to the Chapter and give her reports. It
was her prerogative to assign the women nurses
to the various wards and departments, to send
them to private duty, and to give them permission
to go out. The general supervision of the wards
and of the nursing was her chief function. She
also purchased all supplies and had general control
of the linen-rooms and store-rooms, which were
her special pride. Indeed it seems evident
throughout that the Prioress was more attentive
to the housekeeping than to the actual nursing.
A quaint description is given in the old records
of the duties of the Prioress and her assistant;
of their care of the old linen, which they washed
and bleached for shrouds, bandages, and other

302 A History of Nursing

uses; of the great linen-rooms over the ward of
St. Denis, where they often took a couple of
younger Sisters or some patients to help them to
sew. Here all the bandages and surgical dressings
were made. In the storerooms directly under the
Prioress' care all the jellies, preserves, and sweets
for the whole establishment were made, the fruits
and sugar being provided by the steward. The
Prioress probably felt it necessary to devote
herself especially to the housekeeping, as every
ward had a head Sister or cheftaine, many of
whom had been at their posts for years. A
curious system which had been established also
relieved her of direct responsibility in regard to
the novices. It became the custom for her to
place each novice, as she entered, directly under
the personal charge of some one of the older Sisters.
The elder was called the 'mother in religion"
of her protegee and was responsible for her train-
ing, religious instruction, and general deportment.
But this arrangement, as may easily be imagined,
gave rise at times to much trouble.

The drug department had an old Sister in
charge, with a younger one and a boy to help her.
The two latter carried the drugs to the wards, and
the young Sister did the cleaning in the drug-rooms.

The obstetrical1 division had a midwife in

1 In connection with the obstetrical division was the Tour
du Limbe, a square tower where the still-born infants were
cremated. It was the duty of the Sister to carry the key
and attend to this duty, and to permit no one else to approach
this tower.

The Sisters of the Hotel- Dieu Washing the Linen of the Hospital in the River

Seine

Les Edifices Hospitaliers^ C. Toilet, 1892

Nursing Systems of Two Hospitals 3°3

charge of the practical work, and a Sister to admit
patients and keep order.

All the soiled clothes of the house were col-
lected in receiving rooms under the charge of a
Sister, who guarded them and saw that they were
properly assorted for the wash. No steam laun-
dry nor even wooden tubs had our devoted Sisters
for this tremendous piece of work. Their laundry
was the river Seine, and to wash the clothes the
Sisters waded into its current even in icy win-
ter weather and stood there. Every six weeks
the "great wash' took place. This comprised all
of the more ordinary linen, and that in general
use. The "little wash' went on every day with-
out cessation. It comprised the bed-linen from
acute cases, and the Sisters occupied with it
often had to work night and day. The laundry
service was held in rotation by the Sisters for a
year at a time, a Sister-in-charge directing the
procedures by the river side. Well might it be
said : The Sisters endured with cheerfulness and
without repugnance the stench, the filth, and the
infections of the sick, so insupportable to others
that no other form of penitence could be compared
to this species of martyrdom. No one who saw
the religious Sisters of the Hotel-Dieu not only
do dressings, make beds and bathe the patients,
but also in cold winter weather break the ice in
the river Seine and stand knee-deep in the waer
to wash the filthy clothes, could regard them as
other than holy victims, who from excess of

304 A History of Nursing

love and charity for their neighbours hastened
willingly to the death which they courted amidst
the stenches and infections."1

The Sisters also had charge of the clothes-room
where the clothing of the patients was kept. It
was the custom to sell the unclaimed clothing and
belongings of the dead, and these sales constituted
quite a source of revenue; also, frequently, a source
of infection. It is evident that from early times
the hospital was subject to periods of overcrowd-
ing. There were often five or six times as many
patients as there were beds, and though cases
of small-pox were not then received, and though,
on the whole, in respect to the nursing of con-
tagious cases, the service in the earlier centuries
seems to have been better regulated than later
on, yet mediaeval notions of isolation were not
what they are to-day. Mention of the notorious
overcrowding of the beds of the Hotel-Dieu
reappears in the official complaints for centuries.
While it is true that the custom of putting more
than one patient in a bed was quite general during
the Middle Ages, the Hotel-Dieu of Paris seems to
have had a bad eminence in this respect. It had
even been known that in times of emergency six
patients had been packed into one bed, three with
their heads at the top of the bed, and three at
the foot. This horrible custom has been excused
by the apologists of the early management, and

1 Helyot, vol. iii., chap, xxii., p. 185.

Nursing Systems of Two Hospitals 305

with some plausibility, as being at least kinder
than letting the wretched patients die on the
street.1

Signs of many troubles appear in the middle
of the fourteenth century. In 1368 there was a
contest between the Mother Superior and the
Master which sounds so natural that it might have
happened yesterday. It was the custom of noble
families who gave munificently to the hospital
to send to the Prioress for Sisters to do private
nursing and it was her province to decide as to
these calls. On one occasion, having refused
to send a certain Sister, the latter, (\vho must
have been of a type that still exists) complained
to the Master, who took her part. The Prioress
appealed to the Chapter, and in a written state-
ment the justice of her claim is very well presented .
As the Master was not responsible for her wards
(she contended), he could not judge of the neces-
sities of the same and should not interfere with her
right of deciding whether or no a Sister could be
spared for private nursing. Yet on this occasion
the Prioress was not upheld in her obvious right,
and the debated point, involving the ultimate
authority in the management of the nursing staff,
was left exceedingly befogged. Other and more
serious evils had called for attention. Chevalier
tells us that the general disorder and degradation
in every part of society at the beginning of the

1 Chevalier, op. cit., pp. 59-60.
VOL. i. — ao

306 A History of Nursing

reign of Louis XL was reflected in the staff of
the Hotel- Dieu. Discipline was relaxed and the
deterioration was such that the King called a
committee of investigation. It was probable that
one cause was the impoverishment of the treasury
consequent upon the wars, but a more direct
source of trouble lay in the senility of the Super-
intendent, who had let everything go to rack and
ruin. The Chapter \vanted to give him an assistant,
but among the Brothers there wras not one who
was capable of undertaking such duties. An old
retired Brother of no great ability was called
back and the hospital became the scene of per-
petual insubordination and insolence. Melan-
choly scandals of a moral nature had added to
the disorder. After all, the poor Sisters, over-
worked, ill-fed, and without relaxation other
than prayers and religious exercises, were but
human. In 1354 an unfortunate Sister had been
convicted of infanticide and condemned to four-
teen years' imprisonment, l though her companion
in guilt is not even mentioned with disappro-
bation. The nature of some of the other irre-
gularities is suggested by the often recurring
ordinances of the Chapter : ' that the Sisters
should eat in common"; 'that locks should be
removed from the Sisters' doors"; and, on July 3,
1408, that a little staircase near the room of the
Superintendent should be walled up.2 In 1482

1 Chevalier, p. 1 18.

3 Ibid., Book II, chap. i.

Nursing Systems of Two Hospitals 307

there were rigid inquiries into breaches of the vow
of poverty. The Sisters no longer regarded this
vow. They accumulated money and possessions.
Now also the Chapter decreed that "seriously
ill patients were to have single beds," and still
another command (probably equally futile) went
forth that "those who cooked the meat should
see that it was not repugnant to the sick by
reason of its blackness." 1

In 1496 a dreadful epidemic of syphilis spread
through the hospital, brought by the soldiers
from their Naples campaign. The matron's sheets
were ruined, and the hospital became a centre
of infection.2

In 1497 fresh quarrels broke out between the
staff and the two Proviseurs. Complaints of
'abuses, scandals, disobediences, and insolences"
were so rife that the King and Parliament had to
interfere. The Superintendent was convicted
of gross dishonesty; nevertheless, a band of the
young Brothers and a number of the Sisters
championed his cause with such intensity that
on one occasion they formed a furious mob and
assailed the Brother who had been temporarily
put in charge, and who was really honest, with

1 Chevalier, p. 142.

2 The clergy said that the doctors did not know how to deal
with it, and no isolation hospital was in existence. It was
not until the seventeenth century that the hospital of St.
Louis was built for contagious diseases. It was begun in
1607. finished in 1612.

308 A History of Nursing

sticks, knives, and hatchets. The unhappy Brother
managed to escape half dead and took refuge
in his room, whither the others pursued him and
tried to beat in the door. Even the patients
took sides, and twenty-five or thirty of them
joined forces with the mutinous Sisters and
Brothers. The sick were for the time being neg-
lected and pandemonium reigned. The canons
of Notre Dame, apprised of the revolt, hurried
to the hospital to quell the uprising and implore
the Sisters to return to their duties, but they
were driven from the place with violence and had
to escape by the wicket-gate, for the Sisters
had locked the main doors.1 In time the frenzy
passed and a new Superintendent was installed,
but only to meet with continued insults from the
Sisters and even from the Prioress. Tales of
these doings were carried to court by the court
ladies, who were accustomed at that time to visit
the hospitals to distribute alms. The disorganisa-
tion of the nursing service seemed so complete
that about 1504 an attempt was made by the
governors to introduce a new element. Some
Grey Sisters, Tertiaries of St. Francis, were brought
from Flanders for the women's wards, and on the
men's side Brothers from the order of St. Victor
were tried. The experiment, however, was a
failure and did not last for a year. As a complete
sweep of the old staff had not been made, the
remaining members made life so unpleasant for

1 Chevalier, pp. 150-152.

Nursing Systems of Two Hospitals 309

the new-comers that they were all returned to
Flanders. A better degree of order was finally
attained by the expulsion of several of the un-
manageable Sisters and novices, but naturally
the hospital then suffered from an undue propor-
tion of inexperienced workers.1

Up to this time the clerical control of the
entire hospital foundation had been absolute
and unhampered, but now the civil power inter-
fered and claimed authority, and a struggle began
which lasted continuously for over four centuries.2
In response to the general and emphatic com-
plaints of mismanagement Louis XII., by letters
patent in April, 1505, commanded that the tem-
poral jurisdiction be taken away from the canons
of Notre Dame and confided to secular directors.
His letter begins:

ii Avril, 1505.
DE PAR LE ROY:

Tres chers et bien amez, nous estant derrenierement
en nostre bonne ville et citd de Paris, plusieurs plainc-
tes nous furent faictes touchant le maltraictement
et petit goyvernement de 1'Ostel Dieu de Paris et des
pauvres d'iceluy. . . .

1 See Chevalier, chaps, v., vi.

2 Of the determined struggle between the civil and clerical
powers Feillet tells us, in La miser e au temps de la Fronde,
that the lords and clergy were prone to regard the hospitals
as places for their relatives and their endowments as hered-
itary fortunes. Francis I., Henri II., Charles IX., and Henri
III. issued edicts restricting the monopoly in hospital manage-
ment. In 1612 there were lawsuits pending in many French

310 A History of Nursing

On the second of May Parliament named as di-
rectors Jean le Gendre, Hierosime de Marie, Fran-
cois Coussinot, Henry le Begue, Estienne Huv, Jean
Baudin, Gttillaurne le Caron, Millet Lombard, bour-
geois de Paris, and defined in detail their powers
and functions,1

The directors now began an investigation pre-
paratory to taking the reins of government. Such
resistance as they met in taking over the financial
affairs does not concern our story, but in the
internal management they encountered in the
ancient nursing order a determined and baffling
antagonist, requiring edict after edict from Parlia-
ment itself to quell it. Between 1536 and 1540
there were no less than sixteen different edicts
of Parliament in regard to the Hotel-Dieu. The
number of the nursing and working staff was
a standing grievance. It was said that there
were too many Sisters and that numerous under-
lings were kept. Every monk, nun, and even
upper servant had a servant, amounting in all to
about one hundred persons. Moreover, the Sis-
cities over hospital property. The city of Rheims brought
suit against a religious order which for forty years had not
had a single patient but had used the revenue for other pur-
poses. Another order confiscated yearly 20,000 Hvres in-
tended for the poor. P. 216.

i Notes sur Vancien Hotel-Dieu de Paris. Extraites des Ar-
chives de V Assistance publiqtic; publices par Albiu Rousselct.
Preface par Dr. Bourneville, E. Lecrosnier and Babe, Paris,
1888. From this point on our data are chiefly taken from
this compilation of official records.

Nursing Systems of Two Hospitals 311

ters kept many convalescents in the hospitals,
who were 'never to be seen' when the doctors
made their rounds, and who sometimes hung on
for years, sometimes as patients or sometimes as
helpers, but always as nuisances, for some of them
would sell the surplus of their own extra diet to
the patients, or extract fees from them in various
other ways. There was always a contest going on
with the Prioress to find out the exact number
of her nuns, and to obtain information with respect
to the occurrence of deaths or absences of any
members of her staff. The directors wished to
reduce the number of Sisters to 'six twenties,"
but the Prioress would never produce exact figures,
nor could they learn ho\v many were sent to do
private nursing in the city. They tried to meet
the situation by refusing new applicants, only to
have the Prioress accept them after all. In view
of the facts proving the inhuman overworking of
women in hospitals made evident in the records
of this ancient charity, it is impossible to feel any
sympathy on this point with the directors. The
Sisters had to get the work done, and there is a
limit to human endurance. Even a staff of ' six
twenties'1 cannot be conceived of as adequate
for the performance of all the work of such a
hospital as the Hotel- Dieu, which in those days
sheltered some hundreds of patients. Nor can
the t\vo hundred underlings and convalescents
that they were charged with retaining be re-
garded as in any way the equivalent in labour

3i2 A History of Nursing

capacity of a well-trained modern hospital staff
of servants, such as is now considered indis-
pensable. In 1607 the directors regulated the
number of Sisters as follows:

52 for the wards, including 10 night Sisters.1

1 as doorkeeper

2 in the drug-room

2 in the clothes rooms

3 in the convent (for the housekeeping and
service)

2 in the drying rooms

3 to do the nursing in the convent infirmary
8 in the linen-room

3 for private duty
1 8 for laundry work

2 novices

In this connection also we find the following
remarks: 'Considering the old ones who cannot
work very hard; those who are on the sick list;
those who are likely to be sent to St. Louis and
St. Marcel on emergency, and those sent to private
families, this number cannot be reduced with
safety to the patients."1 In the course of a couple
of centuries some idea as to the demands of the
service dawned upon the directors, and paid serv-
ants were gradually added. Nevertheless we still
fail to find any trace of a humane treatment of
the nurses such as the directors claimed for the
patients. In 1650 a new constitution was given
by the clergy to the Sisters, increasing the pow-

1 Notes, p. 17.

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Nursing Systems of Two Hospitals 313

ers of the Mother Superior, and providing for a
council of six of the wisest Sisters to confer with
her. Private nursing wTas also stopped about
this time. In 1654 the Prioress came before the
directors to beg for more Sisters on the grounds of
the increasing number of patients and the old age
and illness of certain Sisters. The directors de-
cided to look into the matter carefully, but not
to allow more Sisters unless the increase was
absolutely necessary. The Prioress came to an-
other meeting to urge her plea again, but the
directors were still obdurate, though it was evi-
dent that many of the Sisters were so old as to
be almost useless. In 1655 the directors reduced
the number of Sisters to eighty, but now decided
to employ a certain number of paid servants,
and later added ten more to the eighty Sisters.

In 1677 a petition was again brought to the
directors for more help, as the Sisters were ex-
hausted with the weight of the hospital service.
In the two hospitals, the Hotel- Dieu and St. Louis,
there were three thousand and six hundred pa-
tients, and many Sisters had fallen ill or broken
down. The Prioress begged the directors to
relieve the Sisters of the laundry work, and the
directors appointed a committee to see what
could be done. It seems nothing short of cruelty
to find, at this point, such an accusation as this
made against these overburdened women — that
''they were always trying to do nothing." The
Sisters also had grievances on the subject of their

3H A History of Nursing

food. At this same time Sister Heurtel was re-
ported for insubordination because she had refused
to eat with the domestics of the hospital of St.
Louis, Her reason was that she was afraid of
contracting scurvy. One cannot but sympathise
with poor Sister Heurtel, the more so as the
clergy, who were helpless in the matter, did
nothing, and the directors decreed that no other
food should be supplied to her.

In 1692 the directors finally established the
principle of paid domestic service and extended
it throughout the housekeeping departments.
They argued that the wages of paid servants
would cost less than the thieving of a constantly
changing and irregular mass of convalescent
assistants. This decision, quite extensively car-
ried out, brought relief and a better system, and
the laicisation of the hospitals of Paris may be
regarded as dating from this time.1

There were many other lines upon which the
directors may have had a stronger case, although
it is incontrovertible that most of the abuses un-
earthed were not directly blamable to the Sisters
themselves, but to the system under which they
were organised. Many and piteous are the com-
plaints of the directors: The Sisters will not
do the wash, bathe the poor, clean their nails,
cut their hair or do all those necessary things ' ;
they were seditious and ' cast contempt on the
Board of Directors;" they were high-handed;

i Notes, pp. 153, 154.

Nursing Systems of Two Hospitals 315

changed the patients from one ward to another;
'made a pinewood closet in the place of several
beds which they removed for this purpose '
(rather a pitiful and paltry charge) , ' ' although the
same had been refused to them ' ' ; they resented
all interference in ward management and re-
garded the directors as only there to pay the
bills. They were not even willing to submit to
medical authority in the care of the sick, and as
late as 1787 the directors found it necessary to
pass a rule making it absolutely obligatory on
them to obey the physicians' directions. Yet
reappearing through the storm of complaint are
brighter glimpses. In 1737 there was a dreadful
fire in the hospital. Thirty attendants were
injured and seven killed, of whom one was a
Sister; yet the patients were removed from the
wards in such good order that their medicines
were only delayed by two hours.

The clergy were opposed to autopsies and the
Sisters hampered the physicians in this matter.
They continually countermanded the physicians'
orders for medicines and diet. They had strong
prejudices as to treatment.

Some are opposed to venesection ; others to quinine ;
others to mineral waters ; others to emetics ; others to
vesicants, and so on, and in consequence of these
various prejudices, treatment is proportionately
hindered and opposed in the various wards of the
Hotel-Dieu.

So complained the physicians on the staff.

3*6 A History of Nursing

What is most surprising from a modern standpoint
is that the physicians did not yet control the
admission of patients, but that this was also in
the hands of the Sisters, as had been the custom
of the hospitality of the earliest centuries of the
Christian era. In all of this humiliating struggle
the actual factors were the secular and the clerical
powers. Clergy and laymen carried on this
titanic contest with each other and used the
Sisters alternately as weapon and shield. The
poor Sisters, too ignorant to understand what
was going on, went unsuspectingly to their own
destruction. A single illustrative incident will
be sufficient. The disorders in the obstetrical
division were so great that in 1662 the directors
had ordered written regulations to be posted in
the ward. The Sister in charge tore down the
bulletin 'by order of the Spiritual Governors."
The lay directors appealed to Parliament, which
ordered the rules to be again placarded (1663),
under a penalty of 500 livres fine, with costs for
pulling them down. The rules, together with this
parliamentary order, were again posted by the
directors' secretary, accompanied by a hussar,
but within a week they were spattered with mud,
torn, partly pulled down one night and completely
destroyed the next morning by Mother Bazin,
who, emerging fearlessly from her kitchen, seized
the remnant of the parliamentary decree and cast
it into her fire.1 No one was arrested or fined, but

1 Notes. Preface, and p. 137.

Nursing Systems of Two Hospitals 317

Parliament issued a new decree, with a threat of
corporal punishment for the offenders. Again
the orders were posted and again they were torn
down. More official fulminations were promul-
gated, but no punishments were inflicted. The
orders were nailed to wooden slabs and secured
by iron clamps, but the Sisters were equal to the
emergency and covered them \vith pictures. The
directors now plucked up their courage, and legal
steps were taken, resulting in a victory for the
administration.

The complaints were endless and often of a
grave character. Drugs were sold to outsiders,
and the charge of the drug-room was event-
ually transferred from the Sisters to a licensed
apothecary. The supervision was imperfect and
soldiers visited the obstetrical wards at night.1
Dying patients were often transferred to other
hospitals. The Sisters evaded night duty and
handed it over to old women, the directors pro-
testing as follows :

The introduction of these old women hirelings is a
dangerous innovation, not only because the poor will
not respect them as they do the Sisters, and because
serious accidents may happen, but also because it
appears that this innovation presages the gradual
slipping of the service of the poor from the hands of
Sisters into those of hirelings.

In defence of this dereliction the nurses urged

i Report of Dames de Charite'. Notes, pp. 73-75.

318 A History of Nursing

the insufficiency of their numbers and overburden
of work.

The physicians complained emphatically of
the patients' diet, declaring it was wrong to make
the sick observe the rules of fasting prescribed
for well people, and insisting that the soups should
always be made of meat. In 1630 the complaint
was made that the Sisters applied themselves
unduly to meditation, to the frequentation of
sacraments and spiritual conferences and con-
fessions, neglecting the care of the sick and the
teaching of the young novices. The directors
entered a protest on this point, saying:

It is a new and dangerous thing to introduce
meditations, which are continually augmented: the
nursing must be neglected, as one can see the Sisters
pacing up and down with down-bent heads saying
they are meditating. If the patients call or want
something, they do not get it, and the said Sisters
and novices complain that they have no time to pray ;
and those who have been incited to these meditations
by people ignorant of the needs of the service in the
Hotel-Dieu are spoiled by having a medley of notions
put into their heads which make them worthless,
lazy, and insubordinate, so that it would be better
to get rid of them.

In 1634 the clergy insisted that the Sisters should
have half an hour every morning for meditation,
but the directors resisted this demand on the
ground that the Sisters had chosen the care of the
sick as their whole austerity.

Nursing Systems of Two Hospitals 3J9

What they ought to do and to learn is to bandage
and dress the wounds; wash and clean the sick; take
them where they need to go; carry them; cut their
nails and hair; give them their medicines; give ene-
mata ; give them drink and everything else necessary ;
do the washing; sew and mend the linen; lay out the
dead and do other service according as occasion re-
quires.

So said the directors. It is barely possible
that the clergy were humane enough to want to
provide a short resting time for the Sisters,
and it seems rather hard that the half-hour was
refused. Nevertheless, religious exercises were
multiplied, although already fairly numerous;
for, as we learn, the regular routine required each
one, on arising, to pray; then all went to mass;
during dinner and supper they heard religious
reading; after meals they wrent to the chapel to
say grace; every evening there wrere prayers;
every Sunday and feast day a sermon; then the
Sisters often listened to pious exhortations from
able speakers in the wards, and received religious
instruction from the Chapter every week: added
to this there was the time spent in confession
and in preparation for the holy communion,1

In 1630 the Prioress, who had been in the
hospital for forty-eight years had declared her
disapprobation of "innovations,' and affirmed
that the novices paid no attention to what she,
the Prioress, and the head nurses told them, that

i Notes, pp. 46-47.

320 A History of Nursing

they scorned the services of the poor and thought
only of spiritual exercises. Another old Sister
said that the novices were busy all day with
religious exercises even until late at night; con-
sequently the next day they were tired and unfit
for work. Another again, of thirty-three years'
service, said: "Everything is upside down in the
house and all these novelties and particular
devotions, which are being introduced, only dis-
tract the Sisters from their true duty, which is
to nurse the sick." The pharmacy Sister, of
thirty-eight years' service, declared, The novices
to-day are quite unendurable." It was said that
the novices kept themselves secluded in the con-
vent and hardly went near the wards, or at least
not until the old Sisters had finished all the hardest
of the work. "They are more likely to be in
the confessional than by the dying patients."

The clumsy old custom of having the oldest
Sisters responsible for one or more novices made
endless trouble. It gave rise to jealousies, bicker-
ings, favouritism, and gossip. The elders in-
trigued to have certain younger ones put under
their charge ; the younger curried favour with their
own "mothers' and ignored the others, while
no "mother' could be made to see any fault
in her own charges, although she was often treated
with rank ingratitude in return. To end this
difficulty the directors expressed a wish that all
novices should come successively under the rule
of all the "mothers." To carry out this sugges-

, -.

-.•• ac l/Jt 'V<7 ^0/V

From ZfJ Edifices Hospitaliers, C. Toilet, 1892. Hamelin Freres, Montpellier

Nursing Systems of Two Hospitals 321

tion would not have been easy, and another
plan was soon developed. A more than usually
capable woman, Genevieve Bouquet, the daughter
of a watchmaker, had entered the hospital at the
close of the sixteenth century. According to
Helyot and Chevalier her sole motive was the love
of nursing, in which she showed great ability, en-
ergy, and common-sense. They both speak of her
as a reformer of the nursing service. She disap-
proved strongly of the existing system, and
appears to have been the originator of the idea,
afterwards advocated by the clergy, that the
novices should all be placed under one person
for discipline and training. The post of Mistress
of Novices was accordingly created and bestowed
upon Genevieve, probably about 1630. But
this arrangement, which seems so eminently
sensible and is, in fact, in existence in its essential
forms in modern hospitals, only precipitated
another war. The Prioress, her assistant, and
the old Sisters were all deeply incensed, bitterly
jealous and resentful, and Genevieve met with
difficulties and obstructions.1 So high rose the
sea of wrath that the directors held a meeting in
1634 to investigate the state of the house, and
the canons of Notre Dame, equally disturbed,
held a similar investigation at about the same
time. The Prioress and older Sisters complained
bitterly that authority and ward discipline were
disturbed by the Mother of Novices, and one

* Notes, pp. 61-63.

VOL. I. 21

322 A History of Nursing

who had been a Sister for fifty years declared
that to continue a Mother of Novices would be
the ruin of the house.1 The inquiry conducted
by the canons, who called fifty- five Sisters before
them, went deeper and revealed an incredible
state of disorganisation. Jealousy toward the
Mother of Novices was the least important finding.
A deep and violent partisanship was exposed, for
and against the Superintendent, Lesecq, who
was, indeed, as incidental side-lights show, an
adventurer of an unscrupulous and determined
character, long engaged in a tenacious and des-
perate effort to wrest the general control from
the directors and return the whole institution
to its former management. The depositions of
the fifty-five Sisters give a most extraordinary
view of the internal state of the house. Violent
language and even curses were faithfully recorded.
Such terms as 'fool," 'donkey," 'devil incar-
nate' were freely used and there was even a
mention of fists.2 Scandal was hinted at, in-
volving the surgeon and midwife, and every one
blamed every one else for something. Genevieve
Bouquet alone appears to have been calm, moder-
ate, and womanly, or, as the records call her, a
'bonne fille." How long the position of Mistress
of Novices was maintained is not clear, but Gene-
vieve Bouquet was later removed from this post
and sent to the hospital of St. Louis at the time

1 Notes, p. 50.

2 Ibid, pp. 61-63.

Nursing Systems of Two Hospitals 323

of an epidemic. Whether this step in reality
represented the defeat of her plan of systematising
the teaching of the novices is also an open ques-
tion. At St. Louis her practical efficiency was
soon shown. She secured a good water supply
and a place for drying the linen, as well as an
altar. Genevieve subsequently held the posts
of pharmacy Sister and Sister of the lying-in
wards at the Hotel-Dieu, and was then elected
Prioress, remaining in this position for nine years
previous to her death in I665.1

It was in the exciting year 1634, that the
Dames de Charite of Vincent de Paul began their
visits to the Hotel-Dieu. Madame de Goussault,
who obtained the needed permission from the
Bishop of Paris, undoubtedly knew the whole
lamentable state of things, as she used to visit
a personal friend in the sisterhood. Another
formal complaint to the clergy of the numerous
religious exercises required of the Sisters was
sent in by the directors in 1639, which was sup-
ported by the testimony of the Dames de Charite.2
Many specific details of the neglect and suffering
of patients are given, and they add:

1 Helyot, vol. 3, pp. 190-192.

2 The Dames evidently presented official reports of their ob-
servations to the directors, for a report made in September,
x^35» by one of their number, Madame de Jardin, who had
earlier been very active in war relief work and nursing, is
quoted in the Notes, pp. 73-75. It begins: "The ladies see
with concern the approach of winter"; and goes on to
enumerate a number of details which need attention.

324 A History of Nursing

The poor patients die like beasts without any at-
tention or consolation; and this cannot be denied,
for it is of recent proof in the complaints made by the
ladies who daily and charitably visit the said hospital
and see there often the death struggle of the patients,
which causes pity and horror together; and all those
who can, but do not, remedy these things shall answer
therefor to God.1

As time went on the influence and oversight
of the Dames de Charite, the sweet, cheerful assis-
tance of the Daughters, and the character and
energy of Gene vie ve Bouquet brought about a
considerable improvement, and the old hospital
seems to have settled down into a more tranquil
state.

A pleasant and spontaneous testimonial to the
Sisters (who had long received only criticisms)
came from Christopher Rinck, an artisan of
Dresden, who had been taken ill in Paris and
sent to the Hotel-Dieu in 1657. He lay three in
one bed, but in relating his experience said that
those who were dying were removed to a place
alone.

Those are lucky men [wrote Rinck] that come out
alive, and still more fortunate those who can stay out.
And still I cannot sufficiently praise and extol it,
for therein are many poor people served who would
otherwise be undone, and I cannot doubt that God
will requite the Sisters for it. For the nuns [there

» There were no screens in the hospitals.

Nursing Systems of Two Hospitals 325

were 300 of them, he said --how correctly one cannot
tell] endure the great toil, hardships, and smells
with the greatest patience and cheerfulness, and
speak to the sick like a mother, or even better — only
that they feel no sorrow when one dies. I have not
heard the like in any country or city, and they shame
the selfish Lutherans, who mostly keep their charities
for themselves and give the poor nothing. The devil
has put us sorely to shame by this disgrace. Had
these people only our worship and our gospel, their
like for blessedness could not be found." *

During the eighteenth century conditions in the
hospital seem to have grown no better, but even
worse, while the medical profession comes more
prominently to the fore in complaints. In 1756
a long, detailed, and very excellent document
was submitted to the directors by the physicians,
complaining of various defects in the nursing
service and especially with regard to the diets,
which were served without any attention to medi-
cal orders or suitability. The doctors averred
that many deaths were attributable yearly to
errors in diet. Their criticisms were proper and
necessary; and yet, such glaring defects of a
fundamental nature existed at the same time in
the medical and administrative departments,
that one cannot but think of the mote and the
beam in reading of the continuous complaints
of these women for their shortcomings.

In 1770 the paid service was extended to the

1 Schafer, op. cit., vol. ii., p. 138.

326 A History of Nursing

wards, and orders were given to report everything
about the patients to the physicians. Little by
little the Sisters had lost much of their former
territory. The clothes-room, the sale of patients'
belongings, the pharmacy, laundry, and much of
the housekeeping had been taken out of their
hands, and now their field of activity was still
further restricted by the introduction of paid
nurses, and a steady diminution in their own
numbers. New wards were opened in 1787, and
this was made the opportunity of the directors
for introducing a new set of regulations, which
at first applied only to these, but a year later
was extended to all the wards. Three of these
regulations in particular were thoroughly ob-
noxious to the Sisters, so much so that, headed by
the Prioress, they made a last desperate re-
sistance, appealing, though now in vain, to
archbishops and high personages, and even threat-
ening to appeal over the directors' heads to
Parliament. The Sisters took the ground that
their constitution and vows made them subor-
dinate only to their spiritual leaders and that
they could not obey others. It was a logical
but now no longer a final argument.

The three odious regulations, against which
they strove until exhausted, were as follows:

i st. The physicians were to discharge daily
and give lists of all discharged patients to the
inspector of wards, who was to see that they
actually left the hospital.

Nursing Systems of Two Hospitals 327

2nd. One surgeon was to make early rounds
at 6 A.M. and another rounds at 3 P.M.

3rd. The distribution of diets was to be made
under the supervision of the head nurse and a
surgeon, the latter carrying with him a copy of
the diet lists.1

Bitter was the humiliation of the Sisters, and,
from their standpoint of hundreds of years of
tradition, they could see no justification for the
rules. Kindness and charity alone had formerly
regulated the admission and the discharge of
patients. They knew nothing of science and
system.

The distribution of meals (says Chevalier,)
had formerly been a gracious and dignified
ceremony, symbolic of the Church's gifts to her
poor. In stately procession the Head Sister
had gone the rounds of the beds, followed by
bearers carrying the platters and bowls of
food. A sweet quiet reigned and all had
looked forward to the hour. Now the young
surgeons, flippant and irreverent, set a different
standard. They delighted in wearing their hats
in the ward and in showing rudeness to the Sisters,
who had always been treated with respect. Bus-
tle and abruptness replaced the old quiet; in in-
tervals the young men jested in unseemly ways
with the patients, and the Sisters were embarrassed
and hindered in the performance of necessary but
inconvenient duties. 2 It is impossible not to feel

1 Notes, p. 1 88.

2 Chevalier, p. 503.

328 A History of Nursing

great sympathy with the poor Sisters, belated
survivals, as they were, of a former period, for
science does not appear to the best advantage
when personified in a corps of raw young medical
students.

The famous surgeon Desault about this time
prepared a memorial of the defects in the hospital
service. He was an ardent advocate of single
beds, and these had now been introduced into all
the new wards. Only in an emergency were
two patients to be placed in one bed. His letter
shows that the rest of the house still had three or
four patients to a bed, the whole number running
up, often, to between three and four thousand
patients.

In 1783 a distinguished surgeon from Vienna,
Hunczoos, visited Paris, and in describing his
rounds at the Hotel-Dieu said that in one bed he
had noticed one patient dead, two others dying,
and one convalescent.1

The new regulations for the paid servant-nurses
gave one (male or female) to every ten or fifteen
patients, and two orderlies were appointed to each
female ward of more than sixty beds. The nurses
received their uniforms and wages, with an
increase after five years of kind, faithful, and in-
telligent service. After this period they were dis-
tinguished by some special feature of dress, and
regarded as a higher class, and at least one of

i Schafer, op. cit., vol. ii., p. 136.

From Les Edifices Hospitallers, C Toilet, 1892. Hamelin Freres, Montpellier

Nursing Systems of Two Hospitals 329

this higher grade was to be attached to every
group of six younger nurses in a ward or division.
They were subordinate to the Prioress, the head
Sisters, the Inspector of Wards (a male official),
and they were also to show honour and respect to
priests, Sisters, novices, and all officers of the
house, on pain of dismissal. None over forty
years of age were accepted, and after fifteen years'
service in the wards, if invalided, they were
to be supported for life by the hospital. Such
was the beginning of the laicisation of the French
hospitals.

The most expert description of the great hospital
at the end of the eighteenth century has been given
by Tenon, 1 who presented it as a report to the Royal
Academy of Sciences, of which he was a member.
In his time, the Hotel-Dieu, unique in receiving
at any hour and without consideration of age,
sex, country, or religion, cases of fever, contagious
and non-contagious disease, insane, surgical, and
obstetrical patients, contained 1219 beds, 733 of
\vhich were large (52 inches wide — 4 feet, Toilet
says, — six feet high, and six feet long), holding
from four to six patients, and 486 small ones
(three feet wide). They stood in two, three, or
four rows, the small and large being mixed up
together, and so unevenly placed that some could
only be reached from the foot, others only from
the side. The beds were of wood, having wooden

iMemoires stir les Hopitaiix de Paris, by M. Jacques Rene"
Tenon, professor of pathology. 17 88.

330 A History of Nursing

shelves at head and foot to hold the patients'
medicines and glasses, with thick heavy mattresses,
and a feather bed on the top, a bolster, two sheets,
two covers, and bed curtains, which in summer
were made of white muslin and in winter of red
serge. The narrowness of the passages between
the beds made cleaning impossible ; the walls were
filthy with the expectoration of the patients,
and it was impossible to prevent bedbugs. ' Hu-
manity groans," said Tenon, 'to see the big beds
remain." * No other hospital has kept the feather
beds,' he adds, 'those relics of the seventh cen-
tury." The dirty straw mattresses were opened in
the wards at four o'clock in the morning (this being
the time for changing the bedding of all patients
suffering from incontinence) and filled with fresh
straw. The hospital was four stories high, and
had twenty-five wards, twelve for men and thirteen
for wromen. The old hospital had been built in
the most complicated way. There was no cen-
tralisation; each division was a little hospital in
itself, with its own kitchens, little laundry, drying-
rooms, etc. ; each one took care of its own patients'
valuables, clothing, etc. ; thus any unity of ad-
ministration was prevented. There was a special
ward for small-pox patients, wiiere they lay four
and six in a bed, but in other wards there was an
indiscriminate reception of ordinary contagious
with non-contagious diseases, and the patients
were indiscriminately placed in the beds. Tenon
mentions the contagious disorders placed thus in

Nursing Systems of Two Hospitals 33 T

general wards and beds as measles, fevers, dysen-
teries, hydrophobia, scabies, tuberculosis of the
lungs, and general tubercular ailments.1 This
horror especially causes one to wonder whether
the physicians, who sent such minute complaints
to the directors about the Sisters' work, and the
directors, who carried such lengthy grievances
against them to Parliament, ever noticed any-
thing that called for improvement in their own
domains. The clothing of the patients was as little
classified as were the diseases, and that which was
infected was sold with the rest to the public. Yet at
the time that Tenon criticised this the Sisters no
longer had charge of the clothes-rooms or the sale
of unclaimed clothing, these departments having
been taken under the control of the directors.
Other hospitals, such as Beaune, in France, and
Portsmouth and Plymouth in England, fumigated
the patients' clothing and separated that which
had been worn by persons suffering from infectious
disorders, but such a procedure had not been
thought of at the Hotel- Dieu. The itch of the
Hotel-Dieu was of a malign character, peculiar
to the hospital. It was accompanied by sup-
puration and gangrene, and destroyed many eyes.2
'Scabies is almost general." wrote Tenon.
"It is perpetual. The surgeons and nuns con-
tract it, the discharged patients carry it back to
their families, and the Hotel-Dieu is the hotbecl

1 Tenon, pp. 204, 205.

2 Idem, p. 201.

332 A History of Nursing

from which it is spread over Paris." Neglecting
no details he mentioned the hastily rinsed cooking
vessels and dishes indiscriminately used by those
who had scabies and those who had not. Malign
fevers were also endemic at the Hotel-Dieu.
The obstetrical wards were placed in the worst
possible position, exposed to all the effluvia of
the surgical departments. Tenon pointed out
that Vesou, a skilled obstetrician and physician,
had long before advocated placing pregnant wo-
men in wards where they would not be exposed
to surgical poison, but that this recommendation
had never been adopted, and frightful epidemics
of puerperal fever ravaged the maternity wards.
Was this solely the fault of the Sisters, who were
now only in supervisory positions? The con-
dition of the insane was too horrible to be de-
scribed, and patients suffering from hydrophobia
were put in the wards with lunatics.1

Tenon quotes Saviard, who had observed that
tuberculous conditions (then called scrofula) im-
proved faster when exposed to the sunlight, but
this observation had not been followed out or
acted upon.

The operating room, where they trephine, cut,
amputate, contains at once those who have been
and are to be operated upon as well as those under-
going operations. They all see the preparations

i Tenon, p'. 216. Tenon gives a detailed description of the
latrines, so revolting that it taxes the powers of the imagina-
tion.

Nursing Systems of Two Hospitals 333

for torture and hear the cries of agony. ': This
cruelty the Sisters could have had no control over.
The arrangement could only have been designed
for the convenience of the operators.

No statistics were kept at the Hotel-Dieu, and,
as this would have been too absurd a charge to
lay at the Sisters' door, the official charges and
complaints against the management of the nuns
do not refer to it at all!

We also learn from Tenon that the paid secular
nurses had poor and inadequate rooms, no in-
firmary, and that when they were sick they had
to go into the loathsome ward beds with the
patients.1 This one fact alone proves that it was
a definite injustice to load all the blame of insani-
tary conditions in the hospital on the shoulders
of the August inian Sisters, for at this time
secular directors and scientific physicians ruled
with full sway and were entirely responsible for
the conditions under which the secular nurses
lived and performed their duties. Then, too, if
in three hundred years' time the directors had
not been able to correct such hideously insanitary
conditions as those existing in the water-closets
and clothes-rooms, or to see that the physicians
admitted and classified the patients properly and
separated the infectious from the non-infectious
cases, it is hard for even the most staunch sup-
porter of civil government to see wherein their
administration was superior, from the standpoint

i Tenon, p. 314.

334 A History of Nursing

of hygiene, to that of the clergy, especially when
it is known that conditions in other French
hospitals were measurably better.

The French Revolution brought fresh investiga-
tions and some improvements to the Hotel-
Dieu. In 1791 Germain Gamier made a report
detailing all its horrors, not the least of which
was that the slaughter houses for the city were
situated directly under it.1 In 1793 a second
report speaks of great improvements. The large
beds were now banished and only single ones
remained. The wards were aired and washed,
the patients were bathed and dressed, the food
was improved, and the slaughter houses had been
removed by the Committee of Public Health.

It is curious that in all of this long history of
the nursing staff of the Hotel-Dieu no mention
is made of the Brothers. What became of the
thirty Brothers, and what \vas the evolution of
their duties? Did the Brothers continue to do
nursing after the earliest centuries, and was their
work good, or bad, or indifferent? Did they
come to work under the Sisters as assistant nurses ?
For it is evident that the Sisters were in charge of
men's wards. Neither the friends of the ancient

i From records of the Assistance publique during the Revo-
lution. M. Gamier in this report said: 'It is proposed to
institute" (at the hospital) "a course of practical medicine,
\vhich does not exist in France, and to form a school of sur-
gery to educate competent assistants." From this it may be
surmised that the physicians themselves were not beyond
criticism.

Salle Sainte-Marthe

(Hotel-Dieu de Paris)

From Les Edifices Hospitaliers, C. Toilet, 1892. Hamelin Freres, Montpellier

Nursing Systems of Two Hospitals 335

nursing order mention the Brothers with praise,
nor the critics with blame. The physicians give
no sign of having known of their existence. The
directors never refer to them. The truth about
the Brothers will probably never be known.

The order of the Augustinians was suppressed
by the Revolution, but the Sisters were allowed
to remain in the hospital as individuals. Under
the First Consul they were <l provisionally re-
established. " At the present time the famous old
hospital, with its adjunct the hospital of St. Louis,
still retains its composite nursing staff. The
Augustinian Sisters, whose constitution united
their existence so closely with its service, con-
tinue to hold some supervisory posts, although
they have disappeared from the other hospitals
in which their order was once active in nursing,
and although laicisation is now almost complete
in the hospitals of Paris. With numbers dimin-
ished and influence gone, out of touch with the
present, not comprehending the ideals of the
future, only regretting vainly a vanished past,
they still preside passively over the dingy, colour-
less, and dreary wards of the great hospital.1

1 The last remaining Sisters may be finally removed at any
time. The laicisation of the French hospitals in the nine-
teenth century is too large a subject to be considered in the*
present volume, and will be studied with the modern period.

CHAPTER IX

LATER MEDIEVAL ORDERS

THE nursing orders of the later mediaeval
period were so numerous that even an ap-
proximately accurate outline of all can hardly be
given, while an attempt to present full details
would be tedious. We may, however, glance at
the mairi lines of development of the most active
orders and those presenting special features.

Prominent among the various Tertiaries were
the Grey Sisters (Soeurs Grises ; Grauenschwestern ;
also called Sisters of Mercy- -Barmherziore Schwes-

-• o

tern — and Sisters of St. Elizabeth). Founded
in the thirteenth century and bound to all the
works of mercy, these Sisters were especially
devoted to the care of the sick in the hospitals
or in the homes of the patients, and still exist
in considerable numbers. Women of high and
low degree joined this order; but, as in the days
of the early Christians, the maidens and widows
did most of the real practical nursing, whilst the
wives of well-to-do citizens, noble ladies, and
even queens undertook duties compatible with

336

Later Mediaeval Orders 337

their family and social obligations. The nursing,
especially in the hospitals, became a definite
and exacting vocation of this order, and a novi-
tiate or probation time lasting from one to
three years came to be required before the fit-
ness of the Sister was held to be thoroughly
demonstrated.

Two notable nursing orders of men belong to
the sixteenth century. The order of the Fate-
bene-Fratelli, the Brothers of Mercy or Pity,
was founded in Spain in 1538 by a Portuguese,
Jean Ciudad, who had been wounded in battle
and, as was not infrequent in those days, had
vowed to devote his life to God if he recovered.
He was a man of extraordinary spirituality,
simple, earnest, and devoted. He began his
work by renting a house in Granada, where he
gathered patients together and nursed them with
touching devotion. To support them he went
through the streets in the evenings with a basket,
begging for sustenance for his charges. Like
so many other nursing orders the Brothers were
at first all laymen, not monastics. They took
their name from the inscription upon their alms-
boxes — " Fate bene, fratelli," " Brothers, do good."
They were mendicants, and worked without a
rule until 1570, when one was written for them.
They became active in hospital work, and also
visited the sick at home and distributed medicines.
The order spread over a large part of the civilised
world, and within a hundred years after its

VOL. I. 22

338 A History of Nursing

foundation the whole annual number of patients
in its care was close to two hundred thousand.

The Brothers still nurse in some Roman and
Austrian hospitals, the most important of the
former being that of Santo Giovanni Calibita,
on the island where the first /Esculapian temple had
been erected centuries before, and where their
house is connected with the church of St. Bar-
tholomew. In paintings of Juan di Dios the
wards of a hospital are sometimes shown in the
background.

At some time in the latter part of the sixteenth
century an Italian order of hospital brothers was
founded by Camillus, a plain, rough, untutored
native of the wild Abruzzi regions. A youth of
poverty and hardship, and a long series of illnesses
during which he lay in hospitals where he doubt-
less saw much that could have been improved,
stirred this simple and unassuming man to devote
his returning strength and health to the care of
the sick. He formed a brotherhood called the
Clerks Regular, Ministers of the Infirm. Beside
the three regular vows they took a fourth, pledg-
ing themselves to the work of nursing. Camillus
died in 1614, and his humble self -consecration has
enrolled him in the list of canonized saints. Some
of the order are still to be found in Rome. A
sisterhood called the Camellines, or Daughters
of St. Camillus, also served nobly and suffered
much. It wras the special mission of the Sisters
to nurse victims of the plague, and at the time of

Later Mediaeval Orders 339

the last great plague in Barcelona this band of
heroines never returned alive from the pest-
stricken streets and wards, but died there and
their order became extinct. A modern order
in Rome has now taken the name.1

Early in the seventeenth century an order of
Sisters of Charity was founded in Genoa called the
Daughters of Our Lady of Mount Calvary. They
are now more commonly called Brignoline, from
the name of their reformer Emanuele Brignole,
and these Sisters carry on the nursing at present
in a number of hospitals. The founder was Vir-
ginia Bracelli, who was born in Genoa in 1587.

In 1631 Genoa was afflicted by a great famine
and threatened with the plague. In this year Vir-
ginia began taking orphans and rescued girls into
her own house. Later she hired the deserted con-
vent of the Friars of Bregara, known as Mount
Calvary, and the institution took the name of Our
Lady of the Refuge of Mt. Calvary. Virginia
Bracelli provided for these girls partly from her
own means and partly by the alms of rich patri-
cians. In the course of time the girls took the robe
as Tertiaries of St. Francis. In 1641 Virginia
asked and obtained from the government the nom-
ination of a certain number of protectors, who
were to provide for the necessities of the institu-
tion, and three citizens were appointed. To these,
in 1650, was added a fourth protector in the person
of Cardinal Brignole, who exerted himself to

1 Tuker and Malleson, op. cit., in., pp. 304-5.

34° A History of Nursing

reunite the girls in one place, and for this purpose
secured a suitable building with gardens, and
enlarged it at his own expense. After the death
of the foundress, in 1651, Cardinal Brignole be-
thought himself that the girls might very properly
serve in philanthropic institutions, as was done by
the Daughters of St. Vincent de Paul, with whom
he had corresponded. The occasion soon presented
itself, in the shape of the plague of 1656, during
which the Daughters of Our Lady of Refuge per-
formed miracles of heroism and charity. Their
fame, like that of the French order, became
widespread, and many Italian cities invited colo-
nies of these Tertiary Sisters to establish similar
conservatoria. Their rule was almost identical
with that of the Sisters of Charity, with this differ-
ence, that the Brignoline nursed only women. In
recent times, however, beginning with the year 1840,
they have undertaken the care of men as well.1

Tuker and Malleson say that all the hospitals of
Genoa were in their charge, a fact which is of inter-
est in view of Howard's comments that, at the end
of the eighteenth century, he found these hospitals
to be the best in Italy.

Visitors to Florence and Rome regard with spe-
cial interest the unique spectacle of the Brothers
of Mercy, who may often be met on the streets car-
rying a stretcher, or bearing a coffin to interment,

1 Mile, Maria Ortiz, of the Biblioteca Universitaria, Genoa,
and Miss Baxter, of the Ospedale Gesu e Maria, Naples, by
letter.

Later Mediaeval Orders 34 T

dressed in their weird robes and masks of dead
black or pure white. The Brothers are a volunteer
body who act as a sort of first aid corps, or a
substitute for an ambulance service. They agree
to respond in turn to calls for aid, and undertake
such duties as conveying the sick from their homes
to the hospitals, carrying and burying the dead
poor, and assisting in time of emergency. They
also go to the homes where there is illness for cer-
tain specified duties, such as turning, lifting, or mov-
ing the sick, in which they are skilled and gentle.

Like most mediaeval charities, the order of the
Brothers of Mercy was founded as an atonement for
sin. In 1244 the wool trade (art della lana) formed
the nourishing commerce of Florence, and large fairs
were frequently held. The many porters who made
a living by carrying the bales of goods had their
headquarters in a cellar opposite to the Baptistery,
where, when not on duty, they gathered round a large
brasier, and whiled the hours away in gambling,
quarrelling, and swearing. One of their number,
Pietro Borsi, was a pious man, who, by way of putting
down blasphemy, got his comrades to pay a small
fine for every oath they swore. The box on the wall
soon filled, and, city wars being rife, Borsi proposed
to buy six litters on which the porters should carry
sick or wounded persons. This proved so good an
institution that funds were soon added from outside
sources, and money enough was obtained to build an
oratory above the cellar, in which prayers and masses
might be said for the sufferers.

Outside the oratory was a pulpit; there was added

342 A History of Nursing

also a beautiful loggia, which, as time went on, came
to be used as a sort of pound in which were put lost
or strayed children. If not claimed within a certain
time they were taken to the Bigallo hospital for
foundlings. In 1425 the city rulers decreed that the
Misericordia and Bigallo companies should be amalga-
mated, an arrangement which did not work well and
came to an end in fifty years. The Brothers of Mercy
gave their loggia to the Bigallo, whose members,
wholly given up to hospitality, refused to carry the
sick. Then a new church, still standing on the op-
posite side of the Via Calzaioli, was built by the
Brothers, who now changed their red garb for a black
one and formed an organization which has never been
altered from that day to this. Seventy-two Heads
of the Guard are divided into companies of six,
one of which takes office for four months at a time.

Then there are six captains, six counsellors, and
seventy-two congregati, made up in fixed propor-
tions of priests, lay-priests, nobles, and professional
men. To these are added giornati (daily members)
to the number of one hundred and five, of whom
fifteen in rotation hold themselves ready at a mo-
ment's notice to perform any duty required of them.
At the present time the society is rich and influential,
inasmuch as many privileges have been conceded to
it, and many a legacy has enriched its coffers. Its
chronicles tell of much grand and noble labour in
times of pestilence, and many a sick and poor creature
has been tenderly nursed and relieved by the good
Brothers of Mercy, w^hose hands are so strong and
tender at the side of the sick-bed.1

i The Anglo-Italian, Dec. 21, 1895, p. 5.

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Later Mediaeval Orders 343

Similar orders have long existed in Spain. How-
ard, on his travels in the eighteenth century, saw
the members of the Society of Hermandad del
Refugio going about the streets striking on the
pavements with long iron-pointed sticks. At the
sound all the sick or distressed who desired their
services would call them in. They also trans-
ported patients to hospitals or asylums, and main-
tained a refuge of their own for the needy. It was
their custom to hang notices on the walls of the
churches and other public buildings, stating where
they could be found when needed.

Little science, however, remained in Spain after
the expulsion of the Saracens. A medical writer has
said that no country has contributed less to the art
of healing, and for long centuries charity was the
only form of relief.

It is not usual to find a nursing order of women
founded as a memorial to a young man, but such
was the history of the origin of the Sisters of St.
Charles de Nancy, who were established in memory
of Emanuel Chauvenet, a young barrister of
Nancy, by his father, in 1652. The young man
had been noted for his active interest in charity and
relief, and during an epidemic at Toul he had gone
there as a volunteer to nurse the sick and had died
in the service. The order, \vhose first head was
Barbe Thouvenin, herself a volunteer, was at first
secular, and remained so for ten years, but then
became monastic, assuming perpetual vows under
the Augustinian rule, certain modifications being

344 A History of Nursing

provided to meet the exigencies of the nursing ser-
vice. Visiting nursing in the homes of the poor
and general service in -time of epidemics were the
special purposes of this order, which likewise
spread into many hospitals both for men and
women; into military hospitals, almshouses, "and
asylums, and extended into Belgium, Prussia, Bo-
hemia, and Italy. This was one of the few orders
that lived through the French Revolution. 1

Among the many orders formed to take care of
lepers should be mentioned the Sisters of Charity of
the Presentation of the Holy Virgin, a Dominican
congregation established in 1684 by Mother Pous-
sepin. It did not, however, spread far beyond the
French borders.

The Filles de la Sagesse, sometimes called the
Sceurs Grises or Grey Sisters, also survived the
horrors of the Revolution, though they suffered
terribly. Some of the Sisters were guillotined,
others were massacred by the mob, and many were
thrown into prison. But despite danger and per-
secution they did not flinch, but continued to go
forth to nurse their patients and bring them to the
Motherhouse, which was turned into a tempo-
rary hospital. This order was founded in 17 15, at
first for the special work of nursing, but later " to
console all the wants of the poor." Through the
ability and energy of Louise Trichet, the first head
and practically the founder (though the plan for
the order is attributed to Brother Louis Grignon

i Tukerand Malleson, op. cit., iii.,pp. 271-272.

Later Mediaeval Orders 345

de Montf ort) , it became one of the most popular,
widespread, and vigorous communities in France.

Up to a recent date these Sisters had many
houses in France and Belgium and, in addition to
the sick, cared for the blind and for deaf mutes.
Their dress is picturesque — a light grey gown and
apron with a muslin fichu and a peasant's cap of
white muslin.1

The Sisters of St. Vincent de Paul, an order that
separated from the Sisters of Charity at the time of
the Revolution, and works under a rule written in
1799 by Sister Thouret, possesses a notable record
in hospital work, and is especially active in Rome,
where the Sisters are now found in many institu-
tions, among them the famous old hospitals of the
Santo Spirito and of La Consolazione. It would
be hard to find women sweeter in demeanour and
expression than the Sisters now at work in these
large hospitals, or, from the modern standpoint,
nursing more lamentably deficient than that exist-
ing under their supervision. By day, it may pre-
sent a fairly good standard, but by night it is not
to be described.

How numerous the nursing orders "have been is
suggested by Miss Stanley, who has collected into
one list those of the later mediaeval period, and
from this we quote, though not in full :

1612. Sceurs hospitalieres du St. Esprit.

1621. Hospitalieres de Loche.

1 See Tuker and Malleson, op. cit., iii., p. 258.

A History of Nursing

1624. Hospitalieres de la Charite de Notre
Dame. The foundress was a shepherd
girl, whose ideal was to establish hos-
pitals for women, and she actually
accomplished her desire in six or more
towns.

1630. Congregation de la Misericorde de Jesus.

1636. Filles de Ste. Genevieve.

1643. Hospitalieres de la Fleche. Anne of
Melun, Princess of Epinay, belonged
to this association.

1650. Soeurs de St. Joseph au Puy.

1652. Filles de St. Charles Borromeo.

1673. Sceurs Hospitalieres de St. Joseph.

1679. Sisters of Charity, founded by Mme.
Tulard at Evron, on liberal lines; the
Sisters took no vows, could retain
property, and had a five-years proba-
tion with hospital service.

1720. Ordre du Bon Sauveur, to care for in-
sane patients.

1729. Soeurs Hospitalieres d'Evremont.

1773. Sceurs du Saint Sacrement.

1 8 10. Dames du Bon Secours, for visiting
nursing.1

Romance and story throw soft and pleasing
lights on the nursing of the Middle Ages. Thomas
Wright recalls many pretty illustrations to prove
his words : " Mediaeval women were surgeons and
physicians; these were regarded as the natural

» Hospitals and Sisterhoods, pp. 106-115.

Hospitaliere de Dijon

Helyot, Les Ordres Monastiques, etc., vol. viii., p. 231

Later Mediaeval Orders 347

duties of the sex.': He cites the novel of A itcassin
and Nicolette of the thirteenth century, in which
Nicolette manipulated and reduced the dislocation
of a shoulder which Aucassin had received in falling
from his horse. After putting the joint in place
she " took flowers and fresh grass and green leaves
[a charming compress, indeed] and bound them
upon it with the flap of her chemise, and he was
quite healed. ' In Auris and Aurilon, when the
latter is attacked with leprosy, his friend's wife
takes him into a bedroom, removes his clothing,
bathes him herself and puts him to bed. * Again
the high-born maiden in the Roman de la Vio-
lette takes Gerard, who is brought in badly
wounded, into a room and takes off all his armour,
undresses him and puts him to bed, and, having
examined all his wounds, applies an ''ointment
of great efficacy." Likewise Rosamonde 2 applies
precious herbs to Elie's wounds, prepares
a bath for him, and places him in it. Another
quaint testimonial mentioned by Wright is sup-
plied by the illuminated MSS. Historia Scholastica
of 1470, now in the British Museum, in which To-
bit, blind and sick, is lying in bed while his wife,
Anna, sits beside the fire conning a receipt book
and concocting a remedy.

The care given by Rebecca to the wounded
Ivanhoe is too familiar to need recalling here.

The long list of nurses worthy of mention in

1 Womankind in Western Europe, p. 185.

2 Ibid.

348 A History of Nursing

mediaeval times has never been filled, If those
of rank seem to occupy a special place in it, it is
because their names have been more accessi-
ble to historians, and the more humble ones have
been forgotten. Elizabeth, Queen of Portugal,
devoted herself to hospital work. She entered a
monastery in 1325 A. D., but, as she wished to
retain the full control of her property for her work
of mercy, she would take no vows. Her attitude
supplies an interesting and instructive example of
the ways of attaining one's practical purposes in
that day: for then, as ever, economic independ-
ence was an indispensable condition for untram-
melled energy. Elizabeth built a hospital at
Coimbra and a number of refuges and asylums,1
and practised the eight works of mercy,2 to the
mystic number seven previously enumerated be-
ing added the work of reforming sinners.

Isabel of Castile also 'practised the difficult
charity of attending on the sick, with whatever
infectious and repulsive diseases they might be
infected." 3

Catherine of Genoa, who flourished about 1447,
as a young widow entered the hospital of the city
and spent the greater part of her life there. Beside
nursing in the hospital she visited and cared for
the sick in the city, going to their homes and at-

1 Women of Christianity, Kavanagh, p. 99.

2 The eight virtues corresponded to the eight points of the
Knights Hospitallers, and, remotely, to the eight points of the
compass, and early astronomical diagrams.

3Kavanagh, op. cil., p. 102.

The Lady as Physician

From Womankind in Western Europe, by Thomas Wright. Groombridge & Sons,

London, 1859

Later Mediaeval Orders 349

tending the lepers and other patients, and some-
times bringing them into the hospital.1

Another volunteer was Frances, Duchess of
Brittany, who nursed a bitter enemy, — her hus-
band's successor on the ducal throne, who had
treated her with great injustice, — faithfully,
through a long illness, and afterwards retired to a
Carmelite monastery where, during an epidemic,
she nursed the stricken nuns through its whole
course, and, at the end of it, laid down her own
life.2

The early practice of high-born dames and the
custom of the various Tertiaries of visiting the
hospitals for actual work was continued to a late
period. Anne of Austria had certain days for
ministering to the sick in the hospitals. In order
not to be recognised she wore a mask, which, one
would think, must have been anything but pleas-
ant for the patients. One might also be inclined
to suspect that the services of these royal nurses
were limited to smoothing the pillow and serving
a few dainties. However, Evelyn in his Diary
records his surprise on visiting Paris in 1644 to see
' how decently and Christianly the sick in Charite*
were attended, even to delicacy," and he had seen
' noble persons, men and women," there attending
to them.

A hard-working nurse of rank was Mile, de
M61un, daughter of the Prince of Epinay. She

i Kavanagh, op, cit., p. 114.
'Ibid., p. 133.

35° A History of Nursing

established the hospital of Bauge and entered it
for a life service, which lasted thirty years. She
also, like Isabel of Castile, took no vows, because
she wished to retain control of her property and
spend her wealth as she saw fit. 1

Nor were women of high birth alone distin-
guished in nursing. Jeanne Biscot, the daughter
of a respected citizen of Arras, performed true
prodigies of nursing work in war, emergencies, and
epidemics. In 1640, Arras, when besieged, was
like a vast hospital, except that no feature of a
hospital was there, save the sick and wounded.
Jeanne, with a company of her friends, went about
the streets dressing wounds, rescuing, feeding, and
reviving the sick and dying, and finally they went
to the city authorities, begged for, and obtained the
right to use a large public building for a hospital.
Hither they carried their patients, and kept the
house open for nine months, all remaining there
as nurses. Brave and devoted girls as they were,
perhaps it was not on account of faults of com-
mission or omission on their part that an epi-
demic broke out in their wards, so courageously
established. But break out it did, and all of their
patients were removed to some sheds in the marsh
beyond the town. Here Jeanne and her friends
followed them and continued to nurse them as
long as their services were needed.2

An admirable record of neighbourly work in vis-

1 Kavanagh, op. cit., p. 184.
' Ibid.

'J
13

c
o

Q- u

u ^

ex O

Later Mediaeval Orders 35 x

iting nursing is accredited to Mme. de Chantal of
Dijon, the grandmother of Mme. de Sevigne. She
was a woman of position and wealth, possessing
country estates, and endowed with a rare personal-
ity, energy, devotion, and common-sense. More-
over, she appeared to have been entirely superior
to the superstitions which prevailed at that time.
She did not believe in signs, dreams, or relics, and
this rational mind, fervent but clear-seeing, and
warm heart, directed a life of practical well-doing.
Francis de Sales was her friend and counsellor, and
pictured her leading characteristics in the touching
words, "that strong heart of hers, which loved
and willed mightily." Her husband seems to
have been a kindred spirit, for during her married
life her house always sheltered at least one in-
valid. Sometimes it was a destitute old man suf-
fering from an incurable disease — one such case, we
are told, she nursed in her own home for ten
months; again -it was a poor leper lad, friendless
and homeless, repulsive to others, so much so that
she tried to perform all necessary nursing duties
herself for him ; or some pitiful incurable case too
trying for the ordinary institutions.

Whether in town or country she was immedi-
ately notified when any neighbour fell ill, and few
were the days when she did not spend some hours
in the homes of the sick poor. While there, she
worked hard and effectively — no mere visiting and
almsgiving contented her; she washed the pa-
tients, dressed their wounds, made their beds and

352 A History of Nursing

put clean clothing on them, after which she took
home with her the soiled linen, boiled it to free it
from vermin, mended it, and took it back to them.
At her chateau at Bourbilly she once nursed her
peasantry through an epidemic, spending her
whole day in going from one house to another.
Besides nursing the sick she laid out the dead.
Her memory deserves to be kept always green in
the annals of visiting nursing, for surely more prac-
tical personal work has never been recorded.

After her husband's death she organised a visit-
ing nursing order, that of the Visitation of Mary,
and became its head. Francis de Sales wrote the
rule for her. It was simple and required no vow
of poverty, no austerities, and the members were
not cloistered. It was simply a free, voluntary,
and practical association for friendly visiting and
nursing. The members were to visit the sick
daily, bathe, dress, and care for them, and take
home their linen to be washed.

But Mme. de Chantal was ahead of her time in
liberality of ideas, and the free, rational plan on
which her visiting nursing order was established
was not destined to succeed, because it did not
meet with the approval of the clergy. The gradu-
ally growing tendency of the Church throughout
the centuries to emphasise the idea of the strictly
cloistered life and solemn vows had culminated
in the decree passed by the Council of Trent in
1545, that every community of women should be
strictly enclosed. Though in the past the pressure

Later Mediaeval Orders 353

of this chauvinism had been continually felt, it
had been continually evaded, as is shown in the
story of the Beguines.

Mme. de Chantal and Francis de Sales believed
that they could also stem this tide, but it was too
strong for them, and the Order of the Visitation of
Mary only stood on the free and voluntary basis
where they had founded it for four years, from 161 T
to 1615. The opposition to it was too strong and
persistent; "an unenclosed community could
not be tolerated," and it was finally completely
made over according to the conventional pattern. l
The voluntary agreement was replaced by solemn
vows, and the active visiting and nursing work was
given up for the "grille" and enclosure. Lay Sis-
ters were brought in to do the work of the house,
and the order was governed by a bishop. Only
one feature of the original plan remained, and that
was that the aged, infirm, and widows might be
received within the walls. Mme. de Chantal
lived a long and saintly life. She outlived Francis

1 The pioneer of resistance to the decree of enclosure was
Mary Ward, an Englishwoman, born in Kent, in 1585, who
deserves the gratitude of posterity for her courage. She, with
a group of other able women, established a teaching order,
without enclosure, and ruled only by its woman head under
direct allegiance to the Pope. But it was condemned on the
ground that its members had undertaken a task "beyond the
strength and resources of their sex." Mary was imprisoned
as a heretic, schismatic, and rebel. She died in prison, but
her brave companions and their followers kept up the struggle,
until, in 1703, Clement XI. said, " Let women govern women."
See Tukerand Malleson, op. cit., iii.,pp, 255-256-

VOL. i. — 23

354 A History of Nursing

de Sales by many years, and was a revered
and cherished friend of Vincent de Paul. She
died in I6-4.I.1

1 See Tuker and Malleson, op. cit., iii., pp. 287, 288, for
details of order. For outline of Mine, de Chautal's life, Kava-
nagh, op, cit., chap. xi.

CHAPTER X

FRENCH AND SPANISH HOSPITALS IN AMERICA

THE Hotel- Dieu at Quebec is the second oldest
surviving hospital of North America, and like
its sister hospital at Montreal owes its existence to
the zeal and devotion of a woman. To trace its
origin we must go back nearly three hundred
years, and follow the history of that 'advance
guard of the great army of Loyola,'1' as Parkman
has called them, — the early Jesuits, — in their splen-
did efforts to make firm foundations for French
dominion in the infant colony of Canada. No
page of human history tells a tale of greater
heroism, or more absolute self-abnegation, than
that which describes the toils and privations of
those first missionaries, who aimed at nothing
less than the conversion of a continent, and who
' from their hovel on the St. Charles surveyed a
field of labour whose vastness might tire the wings
of thought itself, a scene repellent and appalling,
darkened with omens of peril and woe."1 Here
in a wilderness of vast and gloomy forests or beside

lThe Jesuits in North America, p. 94.

355

356 A History of Nursing

great lonely wastes of water, surrounded on all
sides by fierce, treacherous, and pitiless savages,
destitute of all but the barest necessities of life,
half -sheltered, half -clad, and often half -starved,
the early Jesuit Fathers toiled on with unfaltering
zeal and courage at their appointed task of " luring,
persuading, compelling souls into the fold of
Rome. ' No period of history is wrapped in much
deeper obscurity than that of the Canadian In-
dians before the arrival of the French among them.
While certain tribes undoubtedly knew something
of pictorial writings, their migrations and constant
warfare would probably account for the loss or
destruction of trustworthy records, and for the
survival of little beyond memories and traditions.
We know that when civilisation touched the New
WTorld it found in the primeval forests human
beings roaming about in a state of the most
primitive simplicity and rudeness in which it is
possible for the species to exist; and, although
history tells us that the tribes of Indians in-
habiting the region known as Canada were not
quite the most savage of the red men of America,
yet few can read any account of their general
condition and customs without wondering at times
if there were not some intermediary stage between
brute and man to which some of these beings
belonged, and wondering also at the superhuman
courage and high faith which could bring across
the seas men of noble birth and gentle nurture to

cast in their lot among them. It takes little

French Hospitals in America 357

imagination even to-day, three and a half cen-
turies later, as one journeys down the great
river of the North, the St. Lawrence, to peo-
ple the woods and waters with the primal tribes
of savages who held sway in and over them for
many hundreds of years. We see in imagin-
ation the roving, starving, improvident Algon-
quin, the cruel and ferocious Iroquois, and
hordes of scattered tribes whose long inheritance
of traditions, prejudices, and superstitions offered
almost insurmountable difficulties to the efforts
of the Fathers to convert, to civilise, and control
them.

Four Recollet friars (a mendicant branch of the
great Franciscan order) sailed from Honfleur in
France, and reached Quebec in May, 1615. Here
they built their rude shelter, and here they set
up their altar, before which was celebrated the
first mass ever said in Canada, and from here
they wrent forth on their forlorn hope, praying,
preaching, and struggling with wrhat they be-
lieved to be the powers of darkness. When, some
years later, the Jesuit missionaries appeared on
the scene, and the brave Recollet friars were sup-
planted by them, we find the beginning of the
detailed records of the infant colony, of its life
and growth, from which we now gather the story
of our hospitals and of the care of the sick of the
community. The conditions surrounding the in-
trepid missionaries are vividly described in that
wonderful history the Relations of the Jesuits,

358 History of Nursing

and a fair picture may be gathered of their daily
lives. Their

way of lodging, sleeping, and eating being in every
respect similar to that of the Savages, nature finds
but few alleviations amid all these hardships. A
little Indian corn boiled in water, and for the better
fare of the country a little fish rank with internal
rottenness, or some powdered dry fish as the only
seasoning, — this is the usual food and drink of the
country; as something extra, a little bread made of
their corn baked under the cinders without any
leaven, in which they sometimes mix some beans or
wild fruits — this is one of the great dainties of the
country. Fresh fish and game are articles so rare
that they are not worth mentioning, it being all the
trouble imaginable to secure these for the sick. A
mat upon the ground or upon a piece of bark is your
bed; the fire, your candle; the holes through which
the smoke passes, your windows, which are never
closed; bent poles covered with bark, your walls and
your roof, through which the wind enters from all
sides. In a word, all remains in keeping with the
Savages except the clothing, to which we must yet
begin to reduce ourselves.

Again :

If you go to visit them in their cabins — and you
must go there oftener than once a day if you would
perform your duty as you ought- -you will find there
a miniature picture of Hell — seeing nothing ordinarily
but fire and smoke and on every side naked bodies,
black and half-roasted, mingled pell-mell with the
dogs, which are held as dear as the children of the

French Hospitals in America 359

house and share the beds, plates, and food of their
masters. Everything is in a cloud of dust, and if
you go within you will not reach the end of the cabin
before you are completely befouled with soot, filth,
and dirt.1

Yet they had highly developed ideals of hospit-
ality, and so long as there was food in the village
the poorest and meanest need not suffer want.
" He had but to enter the nearest house, and seat
himself by the fire, when without a word on either
side food was placed before him by the women." 2
Father Le Jeune, the Superior of the mission,
made a journey with the Indians, sleeping at night
upon the ground with a covering of birch bark
provided by a charitable squaw. Though his
bed, he said, had not been made up since the
creation of the world, it was not hard enough to
prevent him from sleeping.

As for beds, they are found everywhere. He who
has built the earth, the rocks, and the woods, has
also made the mattresses and bolsters which one must
use in following the Savages; . . . the women cook
the food (Indian corn) without butter, without meat,
without fat, without oil, without salt, and without
vinegar. Appetite supplies the place of all sauces;
it surpasses all the condiments and appetisers of the
best tables in France.3

1 The Jesuit Relations. Edited by Reuben Gold Thwaite,
vol. xvii., pp. 13, 17.

2 The Jesuits in North America, by Francis Parkman, vol.
i., p. 40.

3 The Jesuit Relations, vol. xxxii., p. 265.

360 History of Nursing

When winter came they suffered much from
the extreme cold, to which they were unaccus-
tomed, and against which they were ill provided.

' Le Jeune's ink froze, and his fingers were
benumbed as he toiled at his declensions and con-
jugations, or translated the paternoster into blun-
dering Algonquin. The water in the cask beside
the fire froze nightly, and the ice was broken
every morning with hatchets."1 Their days and
nights alike were full of danger and peril. "The
fear of the Iroquois was everywhere. ' Over and
over again from all their letters and records does
the picture repeat itself until it is finally im-
movably fixed in our minds and memories, and we
see the little mission-house half buried in snow-
drifts, we partake of their daily meagre fare of
the loathed sagamite? we share their sufferings
during the long, toilsome marches in the bitter
severity of the pitiless Canadian winter. " My
ink is not black enough, ' wrote one missionary,

' to paint our misfortunes in their true colours. '
Sickness was common everywhere among both
French and Indians. There were epidemics of
small-pox, and of other maladies vaguely de-
scribed as the "pestilence,' the "contagion,"
the ' plague. ' Their mode of living made it al-

1 Parkman, op. cit., vol. i., p. 106.

; Their food consisted of sagamite or 'mush' made of
pounded Indian corn, boiled with scraps of smoked fish.
Chaumonot compares it to the paste used for papering the
walls of houses. . . . They used no salt." — Ibid., vol. i., p.

220.

French Hospitals in America 361

most certain that a disease would spread if it
were possible for it to do so. No matter what the
ailment, sick and well lived together and shared
everything in common with the most perfect
indifference, and in a few days the entire number
of inhabitants of a cabin would become infected
and the disease would spread from house to
house and from village to village, finally be-
coming prevalent throughout the country. Scurvy,
or land-disease as it was sometimes called, was
perhaps more prevalent than any other disorder.
It appeared with frequency and swept through
their ranks with devastating effect. It is said
that at one time out of the crews of the three of
Jacques Cartier's vessels, containing altogether
over 100 men, not more than three or four were
free from this disease, and in one of them there
was not a 'whole man' to wait upon the sick.
During the first winter that Champlain and his
little group of Frenchmen were holding Quebec
they were almost wiped out of existence by this
dreaded disease.

Parkman gives the following account of the
epidemic among Cartier's men during their first
winter at Quebec, in 1535:

A malignant scurvy broke out among them. Man
after man went down before the hideous disease till
twenty-five were dead, and only three or four were
left in health. The sound were few to attend the
sick, and the wretched sufferers lay in helpless despair,
dreaming of the sun and the vines of France. The

362 History of Nursing

ground, hard as flint, defied their feeble efforts, and,
unable to bury their dead, they hid them in the
snow-drifts. Cartier appealed to the saints, but they
turned a deaf ear. Then he nailed against a tree an
image of the Virgin, and on a Sunday summoned
forth his woe-begone followers, who, haggard, reeling,
bloated with their maladies, moved in procession to
the spot, and, kneeling in the snow, sang litanies and
psalms of David. That day died Philippe Rouge-
mont of Amboise, aged twenty-two years. The
Holy Virign deigned no other response.1

The Indians, however, had already a remedy
for scurvy in a sort of decoction made apparently
from spruce boughs. Parkman tells of a certain
evergreen, called by him amcda, a decoction of
the leaves of which was sovereign against the
disease. It seems, he said, to have been a spruce,
or more probably an arbor-vitas. The refreshing
beverage known as spruce-beer or root-beer, in
common use now in the country parts of Canada,
may perhaps have thus had its origin among the
early Indian tribes as a cure for disease. Oc-
casionally there was an epidemic of small-pox,
and in an account of such a visitation we get an
illuminating vision of the missionaries at work.

The pestilence, which for two years past had from
time to time visited the Huron towns, now returned
with tenfold violence, and with it soon appeared
a new and fearful scourge, the small-pox. Terror

1 Pioneers of France in the New World, Francis Parkman,
vol. 11., p. 34.

French Hospitals in America 363

was universal. The contagion increased as autumn
advanced; and when winter came, far from ceasing,
as the priests had hoped, its ravages were appalling.
. . . The Jesuits, singly or in pairs, journeyed in the
depth of winter from village to village, ministering
to the sick, and seeking to commend their religious
teachings by their efforts to relieve bodily distress.
Happily perhaps, for their patients, they had no
medicine but a little senna.1 A few raisins were left,
however; and one or two of these, with a spoonful
of sweetened water, were always eagerly accepted
by the sufferers, who thought them endowed with
some mysterious and sovereign efficacy. No house
was left unvisited. As the missionary, physician at
once to body and soul, entered one of these smoky
dens, he saw the inmates, their heads muffled in their
robes of skins, seated around the fires in silent de-
jection. Everywhere was heard the wail of sick
and dying children; and on or under the platforms
at the sides of the house crouched squalid men and
women, in all the stages of the distemper. The Father
approached, made inquiries, spoke words of kindness,
administered his harmless remedies, or offered a bowl
of broth made from game brought in by the French-
man who hunted for the mission. The body cared
for, he next addressed himself to the soul : ' This life
is short, and very miserable. It matters little

1 " The most ordinary of our occupations was that of Physi-
cian, with the object of discrediting more and more their
sorcerers, with their imaginary treatments; although for all
medicine we had nothing to give them save a little piece of
lemon peel, or French squash as they call it, a few raisins
in a little warm water, with a pinch of sugar." — The Jesuit
Relations, vol. xv., p. 69.

364 History of Nursing

whether we live or die, ' The patient remained silent,
or grumbled his dissent. The Jesuit, after enlarging
for a time, in broken Huron, on the brevity and
nothingness of mortal weal or woe, passed next to the
joys of Heaven and the pains of Hell, which he set
forth with his best rhetoric. His pictures of infernal
fires and torturing devils were readily comprehended,
if the listener had consciousness enough to comprehend
anything ; but with respect to the advantages of the
French Paradise he was slow of conviction.

The countless superstitions of the Indians,
absurd and chaotic though many of them were,
were fairly matched by those of the fervent and
devoted Fathers.

These priests lived in an atmosphere of super-
naturalism. Every day had its miracle. Divine
power declared itself in action immediate and direct,
controlling, guiding, or reversing the laws of Nature.
The missionaries did not reject the ordinary cures
for disease or wounds; but they relied far more on a
prayer to the Virgin, a vow to St. Joseph, or the
promise of a neuvaine or nine days' devotion to some
other celestial personage; while the touch of a frag-
ment of a tooth or bone of some departed saint was of
sovereign efficacy to cure sickness, solace pain or
relieve a suffering squaw in the throes of childbirth.
Once Chaumonot having a headache remembered
to have heard of a sick man who regained his health
by commending his case to St. Ignatius and at the
same time putting a medal stamped with his image
into his mouth. Accordingly he tried a similar ex-
periment, putting into his mouth a medal bearing

French Hospitals in America 365

a representation of the Holy Father, which was the
object of his especial devotion. The next morning
found him cured.1

We are unable to doubt, however, that the
Fathers firmly believed in the power of the saints
and angels to render the material and personal
aid for which they prayed.

The "equivocal morality' (a morality built on
the doctrine that all means are permissible for
saving souls from perdition, as Parkman calls it)
of their incessant attempts to baptise the sick
and dying under pretence of giving them some-
thing which they needed of medicine or drink,
forms an interesting phase of their efforts, and
the Relations of the Fathers abound in in-
stances of their skill in the accomplishment of
this object. It was, in fact, the prime object
of their existence to preach, convert, baptise,
to snatch souls from perdition, to bring them into
the fold of the true faith. They had come to plant
the cross in the forests of the great new country,
and, like the crusaders before them, nothing
could quench their fervour and self-sacrificing
devotion. Beside every bed of sickness, in
every instance of suffering, whether of man,
woman, or child, there they were with such
simple help as they knew how to give, never
losing sight for one instant of the real pur-
pose for which they were there. Says Parkman :

i The Jesuits in North America, by Francis Parkman, vol.
i., p. 196.

366 A History of Nursing

But when we see them in the gloomy February of
1637, and the gloomier months that followed, toiling
on foot from one infected town to another, wading
through the sodden snow under the bare and dripping
forests, drenched with incessant rains, till they de-
scried at length through the storm the clustered
dwellings of some barbarous hamlet, when we see
them entering, one after another, these wretched
abodes of misery and darkness, and all for one sole
end, the baptism of the sick and dying — we may smile
at the futility of the object, but we must needs admire
the self-sacrificing zeal with which it was pursued.1
.... The truth is [he adds later] that, with some
of these missionaries, one may throw off trash and
nonsense by the cartload and find under it all a solid
nucleus of saint and hero.

If the relation of their sufferings and their
heroism stirs us profoundly now as we follow
them by rock and torrent through dismal forest,
from Algonquin hut to Huron mission, what a
tremendous interest and enthusiasm these letters
must have kindled in the minds and hearts of
those who read them in their quiet homes in fair
and far-away France. The letters of Father
Le Jeune, one of the most dauntless and devoted
of the entire number of pioneer missionaries who
aspired to martyrdom in the service of their
beloved faith, were passed about from one com-
munity to another, and at court from hand to
hand, until they were actually worn out in their

1 The Jesuits in North America, by Francis Parkman, vol.
i., p. 187.

French Hospitals in America 367

journeyings and could hardly be read. Among
the sisterhoods the conversion of the savages be-
came of paramount importance, of prayers, de-
votions, and fasts.

I know a monastery [writes one of the Fathers]
where for several years there has been continually
day and night some nun before the Blessed Sacrament
soliciting this Bread of life to make itself known to the
poor Savages and enjoyed by them. There has been
found even in the country a Cur6 so zealous for the
salvation of the poor Savages and Parishioners, so
full of kindness that they have made three general
processions and seventy-five fasts; they have taken
the discipline a hundred and twenty- four times; they
have offered eighteen alms-givings and a great many
prayers — all for the conversion of these tribes; is
not that delightful?1

Accompanying the recital of their adventures
came pathetic appeals for money, reinforcements,
and most particularly for the help of women.
With the acumen which has ever been character-
istic of the higher minds of the order, they saw
far into the future, recognising to the full the
value of women's works of charity and mercy.
'If we had a hospital here,' said Le Jeune, 'all
the sick people of the country and all the old
people would be there.' The hospital, they
saw, would be a potent factor in the advancement
of their work. It would bring subjects for con-
version and baptism, helpless, into their hands.

1 The Jesuit Relations vol. xxi., pp. 113, 115.

368 A History of Nursing

Speaking of the Hospital at Dieppe, it is only
necessary to enter the hall of the poor patients to see
the modesty of the sisters who serve them, to con-
sider their kindness in the most annoying cases of
sickness, to cast the eyes over the cleanliness of the
house, to go hence full of affection and to offer a
thousand praises to our Lord. If a monastery like
that were in New France their charity would do
more for the conversion of the savages than all our
journeys and all our sermons.1

The response to these appeals was immediate
and generous. Offers of help came from all sides
and gifts for the missions in great numbers. In
many communities nuns offered themselves to
nurse the sick. The sensation made bv the great

^ C_>

progress ot the ancient faith among the Indians
spread, and finally touched the Duchess d'Aguil-
lon, niece of Cardinal Richelieu, a young widow
devoted to works of chanty and piety. She had
read Le Jeune's Relations for 1635, became in-
terested in the Canadian missions, and his sug-
gestion for the foundation of a hospital at Quebec
made a strong appeal to her. His idea, which
may also perhaps have been encouraged by the
good counsels of St. Vincent, an intimate friend
of the Cardinal, grew into a definite plan, and the
Duchess finally decided to become the foundress
of a hospital in the New World, having apparently
the approval of the Cardinal in her undertaking,
and the more substantial support of a grant of

1 Tire Jesuit Relatioiis, vol. vii., p. 289.

French Hospitals in America 369

land by the Company of New France. Selecting
the Order of Augustines at Dieppe, founded in
1155, one of the oldest orders of hospital nuns
in France, she arranged that some of the Sisters
should be chosen and fully and properly prepared
to carry out her charitable enterprise in this new
and strange country. They were turnished with
contracts, ' obediences and orders'1 from the
archbishops under whose spiritual direction Can-
ada then was, and finally on the 4th of May,
1639, three hospital sisters, together with Madame
de la Peltrie and her group of Ursuline Sisters
who were going to Canada to establish schools
for the little savage children, embarked at Dieppe,
crossed the Atlantic, and on the ist of August,
three months later, landed at Quebec, 'to the
booming of cannon" and the glad welcome of the
entire colony. The "seraphic troops,' as one
of the Fathers who describes the event calls them,
were in ecstasies of delight. They all knelt and
kissed the sacred soil of Canada, and went to
mass at church, later setting forth to visit the new
settlement of Sillery, four miles above Quebec.
Here a Knight of Malta, Noel Brulart de Sillery,
had established through the help of the Jesuits
a settlement of Christian Indians, where between
the river and the woods behind were grouped
a few small log cabins, a church, and some other
buildings. Although it is related that the Duchess
d'Aguillon sent workmen across in advance to
clear up the land granted her, it appears that the

VOL. I. 24

37° A History of Nursing

Sisters at first did not establish themselves in
this spot, but were lodged temporarily in a building
belonging to the Hundred Associates. Into this
as a hospital went the three nuns, and their
baggage had not yet arrived when sick people
were brought to them. The good Fathers had to
lend the Sisters their straw beds to enable them
to perform their first act of charity. Writes one
of the Fathers:

Scarcely had they disembarked before they found
themselves overwhelmed with patients. The hall
of the hospital being too small it was necessary to
erect some cabins fashioned like those of the Savages
in every garden. Not having enough furniture for
so many people they had to cut in two or three pieces
part of the blankets and sheets they had brought
for these poor sick people. In a word, instead of
taking a little rest and refreshing themselves after
the great discomforts they had suffered upon the
sea, they found themselves so burdened and occupied
that we had fear of losing them and their hospital at
its very birth. The sick came from all directions in
such numbers; their stench was so insupportable, the
heat so great, the fresh food so scarce and so poor in
a country so new and strange, that I do not know
how these good Sisters, who almost had not even
leisure in which to take a little sleep, endured all these
hardships.1

"As a matter of fact," writes another, "they
could not contain themselves for gladness. '

1 The Jesuit Relations, vol. xix., pp. 9, n.

French Hospitals in America 37 l

Parkman gives a similar account of their intro-
duction to the New World :

Then came the small-pox carrying death and terror
among the neighbouring Indians. These thronged
to Quebec in misery and desperation, begging succour
from the French. The labours both of the Ursulines
and of the hospital nuns were prodigious. In the
infected air of their miserable hovels, where sick and
dying savages covered the floor, and were packed one
above another in berths — amid all that is most dis-
tressing and most revolting, with little food and less
sleep these women passed the rough beginning of
their new life. Several of them fell ill.1

The epidemic finally passed and the Sisters,
called by savages and Fathers alike " our good
mothers,' settled down into the life of the little
community and began the upbuilding of their
institution. For a few years they lived at Sillery,
where the ruins of their first hospital are still to
be seen, but the Governor, de Montmaquy, finding
himself powerless to defend Sillery against the
Iroquois, urged the Sisters to leave the place
where they were exposed to so many dangers, and
establish themselves at Quebec, which they did.
Here they threw themselves with the utmost
energy, ardour, and courage — and among them
were three of whom it was said that their courage
exceeded their sex — into the affairs of the little
colony, fulfilling abundantly the predictions and

» The Jesuits in North America, by Francis Parkman, vol.
i., p. 276.

372 A History of Nursing

hopes of the Jesuit Fathers as to the important
results which would follow from their work.
The hospital really seems to have been in the
true sense of the word a Hotel-Dieu, Into it
came the sick and the injured, and to it also came
the poor, helpless, and needy, and for each of them
it was a haven of refuge. They called it the House
of Mercy and sometimes the House of Health,
and the Indians grew to love the place, and the
kind and hospitable women who were so strangely
gentle and merciful to them. More sick people
came than the hospital could hold, and little bark
cabins were built outside and near in which they
could be sheltered and cared for. In one year the
nuns had over one hundred and fifty patients.
When the wards and cabins were full they brought
the sick into the chapel. The moment a savage
felt ill he would go to the hospital to be purged
or bled; sometimes to ask for medicines which
he would carry home to his cabin. The Sisters
appear to have carried on an active outdoor
department, and the report of the Mother Su-
perior one year says proudly that they had dis-
pensed over four hundred and fifty medicines.
Their supply of drugs, they said, was exhausted,
but their hearts, on the contrary, were still " quite
whole, ' permitting them to rejoice loudly over a
score of newly baptised converts to the faith.

But the offices of comfort, care, and consolation,
which the Sisters tendered with unfailing gener-
osity to all in need of them, did not cover the

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French Hospitals in America 373

ground of usefulness which they occupied in the
community, the upbuilding of which from the very
first took a definite place in their plans and actions.
The growth of the little settlement at Sillery was
fostered in every way by the Sisters, who bore
a goodly share of the burden of general expenses,
and indeed proved to be so strong a support that
one of the Fathers expressed his doubts as to
whether the little village could subsist without
their help. This interesting evidence of public
spirit and complete identification of the Sisters
with the material needs and interests of the com-
munity comes out not only in the history of the
order in Quebec, but at a later day in a more
striking way in the early history of hospital work
in Montreal. At considerable inconvenience — for
even if they wanted a few herbs, or a half-dozen
of eggs for the sick, they must send a man at a
cost of 30 or 40 sous to Quebec, some miles away,
to get them — the Sisters held closely to their little
foundation at Sillery, where the savages had
learned to turn to them in illness and confidently
expect their help and care. Their larger and
better building at Quebec was, however, being
completed, so that in the event of accident or
trouble they had a safe and certain refuge to which
they could 'prudently and advisedly" retreat.

The power of love to draw forth the best and
brightest emotions of which human nature is
capable is shown in the attitude of the savages
who had once come under the ministrations and

374 A History of Nursing

influences which the hospital gave so freely and
it is pleasant to picture them returning to their
tribes and relating to their astonished brethren
the story of peace and good-will which had brought
'within their ken' a new planet indeed. They
had, says one of the Fathers,

a thousand pleasant things to say about these good
nuns. They call them 'the good,' 'the liberal,'
' the charitable. ' The Mother Superior having
fallen sick these poor Savages were very sorry, the
sick blaming themselves for it. ' It is we who have
made her sick,' they said; "she loves us too much;
why does she do so much for us?' When this good
Mother having recovered entered the hall ' to the
poor ' they knew not how to welcome her enough.
They have good reason to love these good Mothers; for
I do not know that parents have so sweet, so strong,
and so constant an affection for their children as
these good women have for their patients. I have often
seen them so overwhelmed that they were utterly
exhausted; yet I have never heard them complain
either of the too great number of their patients or of
the infection, or of the trouble they gave them. They
have hearts so loving and so tender towards these
poor people that if occasionally some little present
were given them one could be very certain that they
would not use it, however greatly they might need
it, every thing being dedicated and consecrated to
their sick. This charity had to be moderated, and an
order was given them to eat at least a part of the little
gifts that were made to them, especially when they
were not strong. I am not surprised if the Savages

French Hospitals in America 375

recognized very clearly this great charity; loved,
cherished, and honoured them.1

On the other hand the Sisters found in their
patients unlooked-for qualities. Fortitude they
might have expected to find, for the Indian is
trained from childhood into a stoical, an almost
contemptuous endurance of suffering, but pa-
tience under prolonged discomfort, unmurmuring
obedience, grateful recognition for services, these
qualities astonished and delighted them. Sub-
dued by illness, and under the gentle influences
of the Sisters, the savages lost their claim to that
title. ' I have often wondered, " says the Mother,
' how these persons so different in country, age,
and sex, can agree so well. In France a nun
has to be on her guard every day in our house to
prevent disputes among our poor or to quell them ;
and all winter we have not observed the least
discord among our sick Savages — not even a slight
quarrel has arisen."2

A characteristic story is told of some Huron
Indians who were coming down from Three Rivers
to Sillery when one of their number fell sick. His
comrades took him to the hospital, and, lacking
any other refuge, they also found shelter there.
Their companion's illness proved serious and they
could hardly be induced to stir from his side,
assisting him in moving or lifting and, according

1 The Jesuit Relations, vol. xix., p. 23.

2 Ibid., p. 21.

376 A History of Nursing

to the records, supporting his head or body in
positions which gave him relief for four or five
hours at a stretch. When the Sisters brought
anything to the sick man the three others never
failed to rise and thank them for it in their usual
fashion, crying 'Ho, ho, ho.' (An ejaculation
of delight and approval). 'I should be too
tedious, ' writes one of the excellent Fathers,
"were I to relate all the appreciation that the
good Mothers have of the docility and patience
of their sick.' A Hotel-Dieu in the fullest sense
of the word was this primitive little hospital out
upon the frontiers of the world, answering gal-
lantly to every call and strain made upon it by
the needs of the people either in mind, body, or
estate. When the numbers of the sick crowded
their poor little quarters to the extreme limit
they were not turned away, but lodged outside
in bark cabins near the hospital. In that dire
poverty and destitution which is the forerunner
of disease, the savages and other colonists found
shelter within the walls not for days only but for
months. "Old men, women, and children' re-
mained in the hands of the Sisters for several
months during the long winter 'who would havr
died of hardships, ' writes a Father, ' without
such assistance. ' This unquestioning, unstinted
hospitality was evidently looked upon by the
Sisters as one of the clearest and simplest of their
duties, and if at times they had some misgivings
over the inroads thus made upon their scan tyre-

French Hospitals in America 377

sources, they never hesitated when called upon
for action. "It is incredible, "an obsenrant Fath-
er says, "what expenses one is obliged to incur
on such occasions; the misery and necessity is
such that conscience is compelled thereto."1 The
Fathers kept a watchful eye upon the activities
of the Sisters, visited the sick daily and several
times daily if needed, held religious services in
the little hospital chapel, and even advised the
Sisters on the important matters of dress, showing
them how the unserviceable white habit could
be made a serviceable brown with the aid of
butternut juice or, according to some writers,
with a dye made from walnut bark. Sometimes
there was a little lightening of the often op-
pressive picture of sickness, suffering, and poverty
as the following entries in the diary of the Fathers
show. " During the shrove Days the Ursulines,
and especially the hospital nuns, often sent us
pastries, Spanish Wine, etc." "The Hospital
nuns sent a letter in the morning by Monsieur
de St. Sauveur, and the evening before a small
keg of Spanish Wine — about four pots. The
same day I sent them a letter and a book-
Father Suffreu's abridgment."3 ... 'On the
6th the Hospital nuns regaled the hour magni-
ficently et saepe alias multa miserunt."* And the

1 The Jesuit Relations, vol. xxiii., p. 313.

2 Ibid., vol. xxviii., p. 169.

3 Ibid, vol. xxxii., p. 67.
* Ibid., p. 75.

3/8 A History of Nursing

Sisters betray the touch of nature which estab-
lishes their kinship with common humanity in an
occasional assertion of their rights and powers.
The same daily record of one of the Fathers gives
us the following amusing side-light :

The Hospital Nuns having represented their right
of seniority in the country over the Ursulines by
virtue of having built in it two years before the
latter — Item, because the hospitals are always privi-
leged and have the first rank — the course of the
procession was past the temporary altar at the fort
near the flagstaff; then to the hospital; then to the
temporary altar at Monsieur Couillart's; then to the
Ursulines; and thence we came back to the parish
church.1

As the labours of the hospital nuns grew heavier
they turned for assistance to the savage women,
who to their surprise quickly learned the 'prac-
tice of charity' and made, as they admitted,
"excellent hospital Sisters," lifting and carrying
the sick, assisting and serving them in every way,
and preparing their sagamite in their own fashion
much better than the Sisters themselves could do
it. They described thus the work of one of these
women: "She goes for wood and for water, she
does the cooking, she dresses the skins, she makes
the shoes; if they kill some Moose three or four
leagues away she takes her sledge and goes to
bring her burden over the snows. '

1 The Jesuit Relations, vol. xxxii., p. 193.

French Hospitals in America 379

The women proved, as might be expect-
ed, far more impressible than the men; and in
them the Fathers placed great hope, since in
this, the most savage people of the continent,
women held a degree of political influence never
perhaps equalled in any civilised nation.1

After a few years, at the urgent and repeated
requests of the governor, who felt powerless to
defend Sillery against the Iroquois, the Sisters
moved to their larger quarters in Quebec, and
finally in August, 1658, established themselves in
a newly completed building on the spot where will
be found the Hotel-Diet! of to-day, with its com-
munity of Sisters, carrying on the work begun
by the three Sisters who were prepared for it at
Dieppe under the rule of the ancient order of
Saint Augustine nearly three hundred years ago.
In the long intervening period the history of the
hospital reflects more or less clearly the stormy,

1 Women, among the Iroquois, had a council of their own,
which, according to Lafitau, who knew this people well, had
the initiative in discussion, subjects presented by them
being settled in the council of chiefs and elders. In this
latter council the women had an orator, often of their own
sex, to represent them. The matrons had a leading voice in
determining the succession of chiefs. There were also fe-
male chiefs, one of whom, with her attendants, came to
Quebec with an embassy in 1655 (Marie de 1'Incarnation).
. . . The learned Lafitau, whose book appeared in 1724,
dwells at length on the resemblance of the Iroquois to the
ancient Lycians. among whom, according to Grecian writers,
women were in the ascendant. (Mceurs des Salvages, i.
461 (ed. in 4to).

380 A History of Nursing

tumultuous history of its surroundings, where in
and about the rock-built city of Quebec momen-
tous conflicts and victories filled the years and
made the place a mighty battle-ground, whose
very name brings up a flood of heroic memories.
Savage warfare alternated with civilised warfare
(if it can ever be so described), and Parkman
called the place a 'sanguinary chaos/ while
steadily through the years recurs the story of
incessant quarrels of priest with priest, or of all
the black-robed forces with the secular governing
po\ver. Amidst constant bloodshed, and the
strife and discord of political and religious feud
and intrigue, the helpless young colony passed
her first tempestuous years.

The arrival of regiments from France for the
protection and development of the colonists might
mean new strength and life and vigour, or it might
instead mean new and heavy burdens, new cares
and toils. The hospital opened its doors and
received in one day from a regiment just landed
one hundred men stricken with an infectious
disease. They filled the hospital until it was
crowded, and filled also the church and the houses
in the neighbourhood, and ''the nuns were so
spent with their labours that several of them came
near to death. '

Still in the midst of toil and excitement they
never lost sight of their main purpose, as the
following tale of the Sisters' resourcefulness
shows :

French Hospitals in America 381

The priests were busied in converting the Hugue-
nots, a number of whom were detected among the
soldiers and emigrants. One of them proved re-
fractory, declaring with oaths that he would never
renounce his faith. Falling dangerously ill, he was
carried to the hospital, where Mother Catherine de
Saint- Augustin bethought her of a plan of conversion.
She ground to powder a small piece of a bone of
Father Brebeuf, the Jesuit martyr, and secretly
mixed the sacred dust with the patient's gruel; where-
upon, says Mother Juchereau, 'this intractable man
forthwith became gentle as an angel, begged to be
instructed, embraced the faith, and abjured his
errors publicly with an admirable fervour!

A century elapsed, and in that period the
Hotel-Dieu and the Sisters had grown into the
very life of the community, had enlarged the
original buildings, and established new hospital
foundations, had added to their numbers, strength-
ened their financial basis by a careful separation
of hospital and community funds, and had taken
on the character, familiar to all those who know
the history of these orders, of wealth, perma-
nence, and power. "Quebec,' says Parkman,
"sat perched upon her rock, a congregation of
stone houses, churches, palaces, convents, and hos-
pitals. Batteries frowned everywhere — the Chateau
battery, the clergy battery, the Hospital battery. '

The long siege of Quebec was slowly approaching

1 The Old Regime in Canada, by Francis Parkman, vol.
(., p. 241.

3 Montcaim and Wolfe, by Francis Parkrnan, vol. iii., p. 50.

382 A History of Nursing

its climax and in the very thick of all the tumult
and peril, sharing to the full every kind of danger,
giving in full measure every kind of helpful work
in their power, were found the hospitals and the
good Sisters. Often they were awakened by
the blaze of houses burning about them, kindled
by the shells of the enemy, and these shells once
pierced the walls of the Hotel-Dieu, exploding
in the halls and chambers. When the firing came
into such close range that life was greatly en-
dangered the Sisters with others would seek refuge
in buildings a little farther away from the range
of shot, which came near enough on one occasion
to carry away a corner of one of the Sisters' aprons.
Then came the surrender of Quebec to the
English, and the Augustines were in attendance
night and day upon the troops with whom the
hospital was soon filled. One of the officers thus
describes the care given by the Sisters to the sick
and wounded of both English and French armies:

Each patient has his bed, with curtains, allotted
to him, and a nurse to attend him. Every sick or
wounded officer has an apartment to himself, and is
attended by one of these religious Sisters, who in
general are young, handsome, courteous, rigidly
reserved, and very respectful. Their office of nursing
the sick furnishes them with opportunities of taking
great latitudes if they are so disposed; but I never
heard any of them charged with the least levity.1

1 M ontcalm and Wolfe, by Francis Parkman, vol iii.,
P- J75-

French Hospitals in America 383

But quite as pleasant is a later picture of these
same Sisters spending their ' scanty leisure '
knitting long woollen hose for the breechless
Highlanders on guard in the bitter winter weather,
which they gratefully accepted, says Parkman,
though at a loss to know whether modesty or
charity inspired the gift.

As securely placed in the heroic annals of
Canadian history as Florence Nightingale in
English history of the nineteenth century, or as
Fabiola of Rome in the early Christian era, stands
Mile. Jeanne Mance, the founder of the Hotel-
Dieu of Montreal, its first hospital and one of its
earliest buildings. No history of Canada has
been consulted which does not include a more or
less extensive account of her and her work, while
a most complete and exact record of her life in
Canada and of the contemporary events bearing
upon it is found in the Vie de Mile. Mance in two
volumes, by the Abbe Faillon. Mile. Mance be-
longed to one of the most honourable families of
Nogent-le-Roi, a family which had produced a
succession of distinguished magistrates and sol-
diers, several of whom had been ennobled by their
sovereign. One of her brothers, professor in a
university, was celebrated for his profound eru-
dition, but no one of the family ever achieved a
glory so great and lasting as that won by the
subject of this story. The inheritance must have
been good which wrought in her the striking com-
bination of great piety, devotion, and enthusiasm

384 A History of Nursing

with uncommon good sense and a wise and liberal
judgment in the handling of affairs, but Parkman
notes that this combination is not uncommon in
the monastic orders. She is said to have been a
gentlewoman of graceful and distinguished bear-
ing. Her portrait hangs in the hospital and has
been thus described :

Facing . . . the door is a portrait of the foundress,
Jeanne Mance. The face is long and delicate, with
fine and regular features, clear, large, dark eyes, long
straight nose, curly hair escaping from the closely
fitting cap, and a dimpled chin. A short, scant cape
is pinned around the shoulders, and the face, looking
downward, has a pensive expression that reminds the
spectator of the famous Cenci portrait in the Bar-
berini Palace at Rome.1

Since it is evident that from her earliest child-
hood she was deeply religious it seems strange
that she could grow to womanhood and escape
the powerful attraction of the cloister, especially
as the death of her parents had made her mistress
of her own actions and affairs. Her biographer,
it is true, tells us, with what Parkman calls 'ad-
miring gravity,' that at seven years of age she
bound herself to God by a vow of perpetual
chastity. This singular infant, " adds Parkman,
'in due time became a woman. . . . Though an
earnest devotee she felt no vocation for the
cloister yet while still in the world she led the life

1 Maids and Matrons of Xe-ic France, by Mary Sifton Pepper.
George X. Morang & Co., Toronto, 1902, p. 152.

Emile Lacas, Montreal

Mile. Jeanne Mance

Foundress of the Hotel-Dieu in Montreal

From the painting in the entrance hall of the hospital, by permission of the

Sisters of the Hotcl-Dieu de St. Joseph

French Hospitals in America 385

of a nun. ' She could not have known very
much about the New World, and of the proposed
new colony of Montreal had not even heard; but
the widespread interest and enthusiasm aroused
by the Jesuit Relations reached her, and, stirred
by the example of the devoted women who had
given themselves so freely for the mission at Que-
bec, she knew suddenly that her own vocation
was revealed to her, and that she was called to
Canada to tread the perilous path which they
had opened up before her. She was then thirty-
four years old. The events in which she was
destined to play so important a part were mean-
while in a truly miraculous way shaping them-
selves. At the little town of La Fleche on the
Loire a tax-gatherer named Jerome de la Dauver-
siere while at his devotions was visited by a vision
in which a voice commanded him to become the
founder of a new order of hospital Sisters, and to
establish the hospital on the island called Montreal
in Canada. Similarly in another part of France
a young priest named Jean Jacques Olier, later
the Abbe Olier, founder of the Order of St. Sulpice,
was also visited by a vision and the inward voice
directed him to form a society of priests and es-
tablish them on an island called Montreal in
Canada. Neither of these two men knew the
other and they lived in different parts of the
country; yet history asserts "that, while both

1 The Jesuits in North America, by Francis Parkman, vol.
ii., p. 14.

VOL. I. — 25

3S6 A History of Nursing

were totally ignorant of Canadian geography,
they suddenly found themselves in possession,
they knew not how, of the most exact details
concerning Montreal, its size, shape, situation,
soil, climate, and productions." To be sure
the Jesuit Relations were scattered broadcast
:d the story of the Canadian missions had
oused an enthusiastic, in some instances almost
hysterical, emotion, while the name of Montreal
had long before become familiar through the
writings of Champlain; but, as Parkman wisely
reminds us, ' we are entering a region of miracle
.d it is superfluous to look for explanations. -
The illusion in these cases is a part of the history. '
In a suitably strange way these two men were
guided to a meeting in which they knew each

*7^ fJ *>

other at once "to the depths of their hearts,'
though they had never met before; and, convinced
that they had received a direct revelation from
God, the}* set at once about rinding some means
of obeying the Heavenly Voice. They would
plant the banner of Christ in this far-off, savage,
desolate wilderness, and there establish three
communities: one of priests to manage the affairs
of the colony, one of nuns to teach the faith to
children (white and red), and one of Sisters to
nurse the sick. That there was no colony, no
ch :i to teach, no sick to nurse, did not ap-
parently cause them to hesitate for a moment.

* TJie Je; .\~orili America, by Francis Parkman. vol.

ii., p. 6.

French Hospitals in America 387

They enlisted the interest of wealthy and de-
voted friends; formed a company called the Asso-
ciation of Montreal, obtaining control of the
island ; matured their plans, and secured a leader
for their enterprise in the shape of the brave and
good Chomedy de Maissonneuve. .Meanwhile,
in following the direction of the divine will, Mile.
Mance had gone to Paris, consulted certain priests,
and been introduced by them to " many ladies of
rank, wealth, and zeal. ' Obtaining from them
a good supply of money to enable her to carry
out her project and to work for the faith in any
way which might be open to her, and with prac-
tically a pledge (though under strictest secrecy)
from Madame de Bullion that she would establish
later a hospital at Montreal similar to that
at Quebec, Mile. Mance went on to Rochelle,
the port from whence ships sailed for Canada.
There miraculous agencies again took matters in
hand, and soon after arriving she met de la Dau-
versiere at the church door. They had never met
before, they had never even heard of one another,
but every thought and purpose of each was in a
twinkling revealed to the other. They held a
long conversation. She saw in his scheme the
opportunity for which she longed, and committed
herself without hesitation to share in the under-
taking. He found in her the person for whom he
was looking, a woman of intelligence, courage,
and devotion to act as nurse and housekeeper
for the entire company and colony. The ships

388 A History of Nursing

set sail, and after a voyage of about three months
reached Quebec in August, 1641, too late to go
on to Montreal that year. In Quebec, therefore,
they remained for the winter, and a singularly
trying winter it must have been. The good
Brothers and Sisters who had so bravely and cheer-
fully endured untold hardships and laboured un-
ceasingly for the upbuilding of their little colony
could not rise to the idea of a newT and rival mission
which would not be under their authority, and by
every means in their power sought to defeat the
plans of the new company. But they had ill
reckoned the characters of those with whom they
had to deal, and the sturdy honesty and fortitude
of Maissonneuve and Mile. Mance stood proof
against even the subtlest form of opposition. No
argument could weaken them in their purpose.
No difficulty could deter them from accomplishing
it. In the following spring the little group jour-
neyed on from Quebec, and at the end of eleven
days landed at Montreal. Let Parkman tell, as no
other writer has ever told, the exquisite story:

Maissonneuve sprang ashore, and fell on his knees.
His followers imitated his example; and all joined
their voices in enthusiastic songs of thanksgiving.
Tents, baggage, arms, and stores were landed. An
altar was raised on a pleasant spot near at hand. . . .
Now all the company gathered before the shrine. . . .
They kneeled in reverent silence as the Host was
raised aloft; and when the rite was over, the priest
turned and addressed them: "You are a grain of

French Hospitals in America 389

mustard-seed, that shall rise and grow till its branches
overshadow the earth. You are few, but your work
is the work of God. His smile is on you, and your
children shall fill the land. ' The afternoon waned ;
the sun sank behind the western forest, and twilight
came on. Fireflies were twinkling over the darkened
meadow. They caught them, tied them with threads
into shining festoons, and hung them before the altar,
where the Host remained exposed. Then they pitched
their tents, lighted their bivouac fires, stationed their
guards, and lay down to rest. Such was the birth-
night of Montreal. Is this true history, or a romance
of Christian chivalry? It is both.1

Months went by. The canvas tents were re-
placed by wooden buildings protected by pali-
sades, and reinforcements for their number had
come from France, bringing with them a fulfilment
from Mme. de Bullion of her promise to provide
means for building a hospital.2 But Mile. Mance
had by this time realised that the first and most
pressing need of the colonists was not a hospital,
but assistance of quite a different nature. It is
probable that with her characteristic good sense
she saw that means which would aid them to
develop the natural resources of the new country
were of prime importance. Abbe Faillon says
that she thought the funds would be more use-
fully employed if given to the Jesuit Fathers for
the establishment of Huron missions. One of

1 The Jesuits in North America, by Francis Parkman, vol.
ii., p. 24-25.

2 Vie de Mile. Mance, by Abbe Faillon, vol. i., p 35.

39° A History of Nursing

the Jesuit Fathers tells a different story. It is
certain that she wrote to Mme. de Bullion asking
permission to use the money for the welfare of the
community in other ways, and was met by a
peremptory refusal. Although everybody was in
good health and in the event of illness one or two
rooms would at the time have answered every
purpose, the money must be used to build a
hospital and for no other purpose whatsoever, for
had not the building of a hospital been one of the
first objects in establishing the colony? ; The
hospital was intended not only to nurse sick
Frenchmen, but to nurse and convert sick Indians ;
in other words, it was an engine of the mission." 1
After a time the Iroquois in their wanderings
discovered the French settlement, and from
thenceforth peace and safety departed from their
midst. The implacable enemy hung about their
borders, attacking them at intervals and harassing
them continually. They lived in perpetual dread
of this terror and scourge of the wilderness, going
and returning to their work in a body, armed, and
as a further defence placing their households
under the protection of certain saints, and in-
creasing the number of their prayers and devo-
tions. Under these conditions it hardly seemed
wise to defer longer carrying out Mme. de Bullion's
instructions, and accordingly a site was chosen
(that which the Hotel- Dieu still occupies) and

1 The Jesuits in North America, by Francis Parkman, vol.
ii., p. 85.

French Hospitals in America 391

the entire force of the workmen of the colony was
withdrawn from the vitally necessary work of
tilling the soil and set to the construction of the
hospital. They worked diligently and on the 8th
of October, 1644, the hospital was finished, sur-
rounded by palisades, and Mile. Mance estab-
lished therein. The building was dedicated in
the name and honour of St. Joseph to entertain,
nourish, and ' medicamenter' the poor sick
people of the country, and instruct them in all
things necessary to their well-being. The hos-
pital, a wooden building of 'axe-hewn beams,
the crevices filled with mud, the roof of slabs,"1
contained two 'large' wards for patients, a
kitchen, rooms for Mile. Mance and for the ser-
vants. It was sixty feet long by twenty-four
wide. Adjoining it was a small stone oratory.
"These imposing buildings," says a recent writer.
on the subject, "made a deep impression upon the
Indians.' The hospital is described as amply
furnished from France with linen, medicines,
surgical instruments, and other necessities, and
the chapel was supplied with carpets, chande-
liers, crosses, and ornaments. To complete the
outfit were two oxen, three cows, and twenty
sheep. One supposedly indispensable factor in
the handling of a hospital was not there, nor
indeed was he anywhere in the colony at that

J"A Canadian Hospital of the Seventeenth Century,"
Dr. McCrae, The Montreal Medical Journal, July, 1906,
p. 461.

392 A History of Nursing

time; that was a physician. 1 A few of the priests
had some small knowledge of medicine, but Mile.
Mance had not, so far as we can gather, any know-
ledge whatever of the sick and their care; for it
will be remembered that she had not felt drawn
toward the sisterhoods, and the training and
experience in nursing the sick which they offer
she had consequently missed. In her office,
therefore, as founder and directress of the hospital,
she had only her sound sense, excellent judgment,
and wise sympathy to guide her. This may,
perhaps, have been a fairly desirable combination
of qualities with which to offset the superstitious

'Later Canadian history notes among physicians Sarra-
zin, a naturalist as well as a physician, who has left his name
to the botanical genus Sarracenia, of which the curious
American species 5. pur-purea, the "pitcher-plant," was
described by him. His position in the colony was singular
and characteristic. He got little or no pay from his patients;
and, though at one time the only genuine physician in Canada
(C oilier es et Beauharnois an Ministre, 3 Nov., 1702), he was
dependent on the King for support. In 1699 we find him
thanking his Majesty for 300 francs a year, and asking at the
same time for more, as he has nothing else to live on. (Cal-
lieres et Cham pig ny au Ministre, 20 Oct., 1699.) Two years
later the Governor writes that, as he serves almost everybody
without fees, he ought to have another 300 francs. (Ibid.,
5 Oct., 1701.) The additional 300 francs was given him;
but, finding it insufficient, he wanted to leave the colony.
'He is too useful," writes the Governor again; "we cannot
let him go." His yearly pittance of 600 francs, French
money, was at one time reinforced by his salary as member of
the Superior Council. He died at Quebec in 1734. — The
Old Regime in Canada, by Francis Parkman, vol. ii., pp.
168-169, note.

French Hospitals in America 393

element which in the Indian sought for cures by
charms and mystic ceremonies, and in the priest
looked for them through the special intervention
of saints, rather than by means of natural remedies.
For the exercise of all the courage, strength, and
skill which Jeanne Mance possessed there speedily
came a demand in meeting the havoc wrought by
the repeated incursions and attacks of the Iro-
quois. No moment was without peril, and there
were times when the wards of the little hospital
could not contain all the injured and dying who
were brought to them, and it became necessary
to make a ward of the corridor. As it had been
the policy of the colonists from the beginning to
win over the Indians by every available means,
the hospital in the intervals of warfare was often
a place where they were fed and lodged, and
kindly treated.

Atironta, his wife, his grandson, and Jaques Archaro,
Hurons, were lodging at the hospital; we furnished
them a part of their provisions — wheat and eels ; they
supplied their wood. Complaint was made that they
took the place of the sick there. 1

If they could persuade any of them to be nursed,
they were consigned to the tender care of Mile. Mance;
and if a party went to war, their women and child-
ren were taken in charge until their return.2

It is not surprising to find that such wholesale
hospitality made alarming inroads upon the in-

1 The Jesuit Relations, vol. xxvii., pp. 91-93.

2 The Jesuits of North America, vol. ii., p. 86.

394 A History of Nursing

come of the institution, and Mme. de Bullion was
turned to for more help. Her confidence in
Mile. Mance is nowhere more strikingly shown
than in the terms of the gift (of 24,000 pounds),
in which was laid down as a condition of her
generosity that Mile. Mance should remain ad-
ministrator of the hospital until her death and
should be fed and lodged there ; and that after her
death there should be established an order of
nursing Sisters, who would serve the poor free
of charge and not at the expense of the institution .
And an able administrator Jeanne Mance proved,
not only of the hospital, but of many affairs of the
community. When she saw that interest in the
colony was languishing in France she made a
voyage across the ocean and by her enthusiasm
aroused new energy in the Compagnie de Montreal,
obtaining for her people the needed help. When
owing to the continued attacks of the Indians
their little band was being depleted, she knew
that not only was a stronger garrison needed to
defend it, but that it should be increased by more
colonists. Therefore she gave a large sum of
money to Maissonneuve to bring out a considerable
body of soldiers and settlers, requiring from him,
however, in return one hundred arpents of un-
cultivated land for the hospital. As the work
of the latter continued to increase more help was
needed and secured in the shape of three Sisters
of the nursing order of St. Joseph de la Flechc.
who had long been preparing for this work and

French Hospitals in America 395

were awaiting their call. Among them was
Judith de B resoles, daughter of an illustrious
family of Blois, who according to her biographer
began at the somewhat unusual age of five or six
years to exercise charity toward the unfortunate,1
and apparently continued in every form of such
effort open to her during her girlhood. At about
sixteen years of age she left her luxurious home,
and entered a nursing order to prepare herself
suitably for her chosen work. She spent six
months in a pharmacy, profiting so well by her
lessons in chemistry that she is said to have sur-
passed her teacher. Later she was sent into a
hospital, where she "served the sick" six or seven
years. Upon arriving in Montreal she was soon
placed at the head of the nursing force of the little
community, taking the pharmacy in particular
under her care, making with her own hands the
greater number of utensils, and filling also the
offices of dispenser, of cook, of seamstress, and of
laundress. Many years later we have a pleasant
glimpse of her cultivating a little garden where
she grew many wild herbs and, with what she
could remember of her early studies in chemistry,
invented and prepared remedies which gained a
high reputation through all the colony. Mere de
B resoles, as she was then called, appears to have
been looked upon as something of a physician, and
to have been consulted for varieties of maladies,
for which she dispensed remedies freely, and suc-

1 Vie de Mile. Mance, vol. i., p. 188.

396 A History of Nursing

cessfully, in the opinion of the sufferers who had
for her 'une estime singuliere. "*

For many years the history of the Sisters was
the history of the colony. All alike were des-
perately poor, all lived in fear of death, and were
disheartened through dread of the terrible and
apparently unconquerable Iroquois. While their
needs grew greater, they had not yet reached a
very productive stage, and money and supplies
from France came in less frequently, as the first
interest in the colony abated. "To give with
one hand one must receive with the other/' and
the anxious Mother Superior murmured audibly
that hospitals in France were supported by kings
and princes and that holy persons maintained
pupils at seminaries, — but "who thinks," said
she, 'of supporting my patient and providing
him with linen and with bedding? " The clothing of
the Sisters wore out and they had nothing with
which to replace them, so they cheerfully patched
them with any material to be found, and shared
the amusement of their guests when it was im-
possible to decide of wThich material the habit had
been originally made. The rough chamber in
which they lived wras hardly fit for human habi-
tation; the snow drifted in through more than
two hundred chinks in the walls, and one of
their first occupations in the morning was
to remove the snow with a shovel not only
from their rooms but from the wards as

1 Vie de Allle. Mance, vol. i., pp. 200-201.

French Hospitals in America 397

well.1 "Their food froze on the table before
them; everything froze, even the bread, which
became as hard as rocks and had to be thawed
out before the fire. ' It is possible that in the
effort to carry their self-denial and self-mortifi-
cations to the extreme point some of this severity
might have been voluntarily accepted; for in a
country of limitless forests it is hard to think
they could not have found wood enough to
bring more warmth into their dwelling.

Under these and all other adverse conditions
Jeanne Mance continued steadfast at her post,
toiling patiently and bringing her wise and
prudent judgment to bear upon every situa-
tion. The interest of the colony was hers, and its
troubles were hers, and all that she could do to
strengthen, support, and develop it was her duty
and her joy. At times she seemed the mainstay
of the entire colony ; and when matters became too
difficult to endure it was she who \vould make the
long journey across to France, awaken the dor-
mant memories and energies of those who had
originally devoted themselves to the establishing
of the new mission, and, securing money and sup-
plies, come back to bring fresh hope and vigour
to her beloved colony. Realising her robust
strength of character, it is almost with a shock
that one reads the story of her broken and badly
set arm, which apparently could not be cured,
and was for long a useless and painful member,

1 Vie de Mile. Mance, vol. i., p. 185.

398 A History of Nursing

but was instantly restored by touching the box
in which lay the heart of the departed Abbe Olier.
For this "medical aid' for her injured arm Mile.
Mance was obliged to return to France, and while
she was there the ecclesiastical authorities at
Montreal, wishing to strengthen and unite the
religious orders, brought from Quebec two
hospital nuns, with the idea of seeing that the
management of the hospital in Montreal in her
absence was placed in their hands. The historian
relates that the good Quebec Sisters were re-
ceived with cold politeness, and the hospital was
not placed under their control. This question
must have been of some importance, for it
comes up again, and later the hospital Sisters of
Montreal, in their desire for independent author-
ity, were finally obliged to appeal to Pope Alex-
ander VII. , who constituted them a distinct
order under their chosen title of Sisters of St.
Joseph. By the end of the century the affairs of
the community were on a comparatively stable
basis, and the early, stormy years of the hospital
gave place to less eventful ones as the colony grew
in numbers and took on something of the aspect
of the older civilisation from whence it sprang.
The number of the Sisters grew from three to
thirty; there were new and greatly enlarged
buildings. The hospital, always a force and
power in the colony, had grown into its very life,
and the charity begun by private hands was now
partly maintained by the French government.

French Hospitals in America 399

The two following centuries tell the story of con-
tinued growth and of continued faithful work for
the sick and for the general welfare of the people.
\Vhen ships bringing soldiers brought also a
frightful pestilence which spread through the whole
city, the Sisters opened wide their doors until the
patients filled the wards, filled the halls, filled
their chapel, and finally the Sisters gave up their
own dormitory to make place for them, nursing
them with unwearied patience and devotion.

Following the conquest of Canada by the English
and the revolution in France, all sources of hos-
pital income ceased, and, in the general extreme
poverty and misery which the unsettled state of
affairs in the country induced, the Sisters shared
fully. How, with no income, could they main-
tain their beloved hospital? One good Sister,
the treasurer of the institution, prayed fervently,
remained in deep thought for twenty-four hours,
and then opened a bakery and was soon turning
out some hundreds of loaves daily, selling them
and applying the proceeds to hospital needs.
"During thirty years Sister le Pailleur worked
for her bakery."1 Later this enterprising Sister
started a new industry- -that of soap-making.
Sewing, making wax candles, and other lighter
activities had always been carried on, but from
these larger and more stable industries a con-
siderable revenue was received for the hospital.
Many years after this their claims in France were

1 Vie de Mile. Mance, vol. ii., p. 283.

400 A History of Nursing

looked into and a part of their lost funds recovered.
It is impossible to follow up to the present day
the work of the Hospital Sisters of St. Joseph,
nor is it necessary. The spirit which carried
the first members unflinchingly through the hard-
ships and perils of the early years has lived on in
the order — its most precious inheritance. It
carried them beyond their cloister walls and into
those long sheds at Point St. Charles, where
in 1847 thousands of newly arrived emigrants
were stricken with ship fever, and where through
a\vful months they shared the heroic labours
among the sick of the Sisters of Charity. It car-
ried a small band of them many years ago into
the leper settlement of Tracadie, to take up the
burden of caring for those whose affliction is
desolation. With his matchless powers of de-
scription, Parkman has placed before us a picture
of these women which will stand for all time:

It is difficult to conceive a self - abnegation
more complete than that of the hospital nuns of
Quebec and Montreal. In the almost total absence
of trained and skilled physicians the burden of the
sick and wounded fell upon them. Of the two com-
munities that of Montreal was the more wretchedly
destitute, while that of Quebec was exposed, perhaps,
to greater dangers. Nearly every ship from France
brought some form of infection and all infection
found its way to the Hotel-Dieu of Quebec. The nuns
died, but they never complained. Removed from
the arena of ecclesiastical strife, too busy for the
morbidness of the cloister, too much absorbed in

Figure of Jeanne Mance
From the Maisonneuve Monument in the Place d'Armes, Montreal, by

Philippe Hebert
By permission of Little, Brown & Co.

French Hospitals in America 401

practical benevolence to become the prey of illusions,
they and their sister community were models of that
benign and tender charity of which the Roman
Catholic Church is so rich in examples.1

Overlooking the older, eastern part of the city
of Montreal, at the foot of Mount Royal, stands
the Hotel-Dieu. It is an interesting, though
comparatively modern structure, covering a large
area. It holds about 280 patients, who are cared
for by one hundred " professed Sisters. • The
portrait of the foundress meets you as you enter
the door. Mile. Mance died in the month of June,
1673, at the age of sixty-seven years. : That
great servant of God, having lived to assure the
establishment of the colony of Villemarie and of
the hospital of St. Joseph, had asked that her
body be buried in the Church of the Institution
and her heart in the church of the parish as soon
as it could be built."2 Her wishes were carried
out.

It is always to be remembered that Mile. Mance
herself never took the veil, believing that she
could do better work for the community by
keeping herself free from regular vows.

Other orders have been founded in Canada
and other hospitals established whose history
would well repay careful study. The Sisters
of Charity (the grey nuns), in particular, have
a long record of noble and far-reaching work

1 The Old Regime in Canada, vol. ii., pp. 157-158.

2 Vie de Mile. Mance, vol. ii,, p. 43.

VOL. i. — 26

402 A History of Nursing

which it would be a delight to tell. With the
story, however, of the two older and typical Cana-
dian foundations this account of the early
Canadian nursing orders must close.

OLD SPANISH HOSPITALS IN MEXICO

Still older than these old hospitals of Canada
are those dating from the Spanish occupation of
Mexico. None remain from ancient times, though
Bancroft in his Native Races of the Pacific States of
North America says that in all the larger cities
of ancient Mexico there were hospitals amply en-
dowed, attended by physicians, surgeons, and
nurses, and that the Mexicans had studied and
practised medicine from ancient times. (Women
physicians were common, and all the obstetricians
were women.)

The stern conqueror Cortes built, prior to 1524,
the hospital of the Immaculate Conception, which
now stands in the city of Mexico. The site chosen
Was that where Cortes and his followers first met
Montezuma and his chieftains, this land after-
wards being bestowed upon Cortes by Charles V.

A miracle- wrorking image presented later to the
church adjoining the hospital gave to both the
name of Jesus Nazareno. In his will Cortes
explained that he had founded the hospital ' in
recognition of the graces and mercies that God
had bestowed upon him by the discovery and
conquest of New Spain, and as an exoneration

Spanish Hospitals in America 403

or satisfaction for any forgotten fault or load
which might weigh on his conscience and for
which he could not make special or particular
atonement. ' The nursing in the hospital was
provided by a brotherhood under the patronage
of the bishop.

After his death the endowment was administered
by a superintendent and has continued to be
under private management. It now belongs to
the dukes of Terranova y Montaleone, Cortes 's
Italian descendants, who nominate and maintain
an agent to supervise the hospital.

The second oldest hospital in America was that
of "Santa Fe,' founded in 1531 by a remarkable
man who became bishop of Michoacan, and who
supported it at his own expense, besides forming
at Santa Fe a community of thirty thousand
Indians who lived like monks, practising hos-
pitality and all the works of charity.1

1 We are indebted to Mrs. Zelia Nuttall for the information
relating to the Spanish hospitals in Mexico.

CHAPTER XI

ST. VINCENT DE PAUL AND THE SISTERS OF

CHARITY

A MORE troubled and unhappy period in the
lives of the people of Europe, at any rate
of those of the humbler classes, could hardly be
found than those years during which Vincent de
Paul exercised his long and arduous ministry.
The horrors of the Thirty Years' War, the miseries
at the time of the Fronde, the devastation caused
by famine and pestilence following after and
more terrible even than the wars, the tragedies
of the galley-slaves of the Mediterranean, the
destitution of the numerous religious refugees
from England- -these conditions formed the
setting of his unceasing labours for the ameli-
oration of human misery, conditions which
might well have appalled even the armies of
relief that were mobilised by his great organis-
ing genius and drilled and inspired by his
devotion. To estimate correctly the heroic
proportion of Vincent's work and the extra-
ordinary simplicity of his character it would be
necessary to make a study of his age and con-

404

Vincent de Paul's Sisters of Charity 405

temporaries — lay, political, and religious - -quite
Impossible for the scope of the present book, but
indispensable for the student. His simplicity
was that of all truly great persons. His humility
-one of his most striking characteristics - -was
equalled by his plain, abundant common-sense,
and both were combined with the rare and moving
eloquence of a powerful mind expressing itself
from the sole standpoint of entire unselfishness.
His humble birth, of good peasant stock 1 his
plain and unprepossessing figure in its coarse and
patched cassock, which he wore alike to the court
of France and to the mission church; his counte-
nance, not at all beautiful except for an "ex-
pression of rare humility, simplicity, and kind-
ness"2; the deep melancholy which fell upon him
for four years before he finally entered upon his
work; his unmoved resistance to political pressure
and influence ; his refusal to defend himself against
the calumnies which again and again assailed
him; his courage before difficulties, and his close
personal interest in the individuals for whom and
with whom he laboured, cannot fail to inspire
affection, admiration, and respect.

But we must pass over the incidents of his early
life, his travels and captivity in Tunis, his interest

1 The work chiefly followed in relation to Vincent is the
History of St. Vincent de Paid by Monseigneur Bougaud ;
translated from the 2nd French edition by the Rev. Joseph
Brady. Longmans, Green & Co., London, 1899.

2 Ibid., p. 3.

406 A History of Nursing

in the medical knowledge of his captor, and the
romantic incidents of his second captivity, his
visit to Rome and his mission to Henry IV., his
parish work in a country district, --which afforded
him the happiest time of his life, --his sojourn in
the powerful and prominent de Gondi family,
and his early missions — and come to his great
works of organisation among men and women
which have had so definite an influence from that
time to the present day. In Paris, he had settled
purposely near La Charite (which Evelyn com-
mended for its admirable care of the sick), and
asked as a favour from the Brothers of St. John
of God who were taking charge of the nursing
that the}' would permit him to come and assist
them in the hospital. As the Brothers were few
in number (for their order had but recently ex-
tended from Spain into France) they were helped
in the nursing by volunteers- 'lords, noble
ladies, priests, and even bishops ' -who came daily
to attend the sick. Hither also came Vincent
every morning to dress wounds and to wait upon
the patients. It was in the little parish of Cha-
tillon-les-Dombes that his first organised charity
was started. Having been asked to speak in
church of a poor and needy family of which all the
members were ill, he found afterwards that many
persons had gone to relieve them. ' Behold, '
said he, "noble but ill-regulated charity. These
poor people, provided with too much now, must
allow some to perish and then they will be in

Vincent de Paul's Sisters of Charity 40?

want just as before."1 Ke went to two ladies,
one of whom had told him about the family, and
asked them to assist in bringing together a group
of well-disposed women. ' I suggested to them
to club together to do the needful every day,-
not only for this family, but for others that might
turn up in the future. This was the begin-
ning of the Association of Charity. ' With good
sense he watched the work of this group for three
months before finally organising them, and then
framed a simple constitution, under which each
member had a vote, and any Christian woman,
married, widow, or single, who had the consent
of her parents or husband, could join.

This Association of Charity was more like a
modern church society than any previous form of
charitable activity. The members elected from
among themselves a president, an assistant,
(vice-president), and a treasurer, who held office
for three years. Some faithful layman or member
of the clergy was to be the bursar, and the \vork
was under the general supervision of the parish
priest. No vows or promises of any kind
were made, the members simply acting under
the adopted regulations. The association at first
comprised a membership of eleven women. The
first meeting was held in the church; Mile. Baschet
was elected president and Mile. Brie treasurer.
The report of the meeting, dated Dec. 8, 1617,

1 Bougaud, op. cit., vol. i., p. 64.
^ Ibid.

A History of Nursing

was signed by Vincent de Paul, who himself
desired to hold no office, but only to appear as the
advocate of the poor. The rules were approved
by the archbishop of Lyons. Very quaint and
practical were the directions for the work of the
members :

The Ladies of Charity shall visit only those whose
cases have been examined and passed upon by the
president, assistant, and treasurer. . . .

The lady who visits shall get the nourishment
from the treasurer, cook it, and, bringing it to the
invalids, cheerfully and kindly salute them on enter-
ing their apartments. She shall arrange the tray
on the bed, spreading a napkin over it, and placing
on it a glass, spoon, and bread-roll. Next she shall
wash the sick person's hands, say grace, and then
having poured out the soup and put the meat on a
plate she shall arrange all on the tray. She shall
kindly invite the sick person to eat . . . doing all in
a spirit of love, as if dealing with her own child. . . .
She shall try to cheer the invalid if downcast, cutting
his food and pouring out the drink. Thus having
set things going, if there is any one at hand she shall
leave the rest to him and go on to the next sick
person, whom she shall treat in the same way. She
shall remember always to begin with those who have
some one to help them, and to finish with those who
have no one, so as to be able to remain a longer time
with them. In the evening she shall return with the
supper, and go through the same arrangement as
before. Each invalid shall receive as much bread
as is necessary, with a quarter of a pound of mutton
or boiled veal for dinner, and as much roast for supper,

Vincent de Paul's Sisters of Charity 4°9

except on Sundays and feasts, when boiled chicken
shall be given, and two or three times a week minced
pie. Those who have no fever may get a pint of wine
every day, half in the morning and half in the evening.

And since the object of this institution is not only
to assist the poor corporally but also spiritually, the
members shall endeavour to make it their aim to dis-
pose those whom they succour to lead better lives,
and prepare for death those who are dying, directing
their visits to this end, and frequently asking God in
prayer for this object. The dead shall be buried at
the expense of the association, the ladies obtaining
a shroud and purchasing a grave if the deceased has
no means. They shall assist at the funerals if
convenient, acting as mothers who follow their
children to the grave.1

Among the most active members of the young
association were Mile, le Gras, <l so wise, so prudent,
so capable," and her friend Mile. Pollalion, who
was more confident and decisive than she; there
was Mme. de Lamoignon, who was called the
"Mother of the Poor (so that when she met
Vincent on the street people would say 'See the
father of the poor going to see the mother of the
poor "), and Mme. de Miramion. who had wished
to become a nun but had been dissuaded from
this step by Vincent. A special ward in the Hotel-
Dieu for old infirm priests had been her gift, and
during the famine of 1651 she fed over 2000
people daily. She became the head of the rapidly
growing Association of Charity, which Vincent

1 Bougaud, op. cit., vol. i., pp. 67-68.

410 A History of Nursing

meantime was indefatigably extending to other
towns and provinces. At first all the branches
were composed of women, but later on he founded
a branch for men at Folleville. Of the men he
expected more in the line of prevention ; his ideal
was to suppress professional mendicancy, while
assisting all of the really needy. 1 He divided the
poor into three classes — first, those who could not
earn: children, the aged, cripples, the sick — to
these the association was to give everything
necessary; second, those who could earn half
their support - -these w^ere to receive the other
half; third, those who could earn one fourth-
these were to obtain the other three fourths from
the society. Outside of these all who were able
to wrork must not be allowed to beg, and to this
end the order enlisted the co-operation of the
mayors and councils of the various cities in se-
curing ordinances forbidding begging and recom-
mending the public not to give desultory alms.
Vincent established night refuges for tramps,
farm colonies, and town workshops where trades
were taught. His plans for suppressing mendi-
cancy, which at that time was a public pest,
appealed to the intelligent public, and in a very
short time officials in all the towns were trying
to introduce this reform according to his directions.

1 Feillet says Vincent was not actually the first founder of
organised charity, but that a magistrate of Rouen, Charles
Maignart de Bernicres, long forgotten, had anticipated this
p irt of his work. — La Misere au temps de la Fronde (1862),
pp. 226-228.

J. Settegast

F. Schafer, Paris
Saint Vincent de Paul

F. Keller

Vincent de Paul's Sisters of Charity 411

These emphasised: (i) the separating of the sick
from well paupers; (2) the entrusting of the sick
to women who would visit and comfort them;
(3) the supplying of work to the able-bodied ;
( i) provisions for teaching trades to young people ;
(5) the giving of alms to those who were unable
to work. His statesmanlike plans were, howeA*er,
opposed by certain jealous officials, one of whom,
the Lieutenant of Beauvais, entered a formal
protest in which he complained that a certain
priest named Vincent had in the past fifteen days
caused to be assembled a large number of women,
whom he had persuaded to join an association,
in defiance of the law that forbade any one to
suggest or to establish any society without having
obtained the king's letters-patent. The protest
further stated that about three hundred women
had joined and that they were meeting frequently
to perform their duties, which ought not to be
tolerated. It does not, however, appear that
either the king or any higher officials paid any
attention to this complaint.1

Vincent was occupied in this kind of work from
1617 to 1621. He next took up the rescue and
relief of the galley-slaves. This mission, which
alone would have been enough to fill the time
of many a man, we must pass over, only men-
tioning that in order to return a certain young
galley-slave to his family, who bitterly needed
him and from whom he had been cruelly torn,

1 Bougaud, op. cit., vol. i., pp. 85, 86.

412 A History of Nursing

Vincent himself took the place of the escaped
prisoner, and served as a galley-slave until his
identity was discovered. After his return to
Paris, against his wish he was placed by Anne
of Austria upon a council to select fit men for
positions in the church. But he was soon again
deep in his charity organisation work, forming
a Paris assembly of Dames de Charite, on lines
similar to those of the associations which had been
established in the provinces. This assembly,
however, had begun in quite an unpremeditated
way, and had not arisen from the direct initiative
of Vincent; neither did he or the ladies at first
dream that, as an outcome of their organisation,
there would develop the now world-famed order
of the Sisters of Charity.

The initial steps had been taken by Mme. de
Goussault, an admirable woman, possessing in-
tellect, prudence, and common-sense, who had
long been one of Vincent's right-hand helpers in
his works of charity, and with whom he had been
wont to consult on many matters. Her share
in bringing about reforms in hospital manage-
ment was a forecast of the work of women in the
nineteenth century. She often visited the Hotel-
Dieu, where she had a friend among the nuns, and
on her visits there she saw so many disorders
and abuses calling for remedy that she finally
went to Vincent to engage his co-operation in
attempting some reform. He hesitated about
interfering in the management of the hospital, but

Vincent de Paul's Sisters of Charity 413

Mme. de Goussault was determined that some-
thing should be done, and would not let the matter
rest. She went to the Archbishop of Paris and
obtained from him a letter to Vincent, giving
him authority to organise a definite and system-
atic visiting service for the great hospital.
Following this a meeting was called at the house
of Mme. de Goussault, and the Dames de Charite
were successfully launched in Paris for active
public service. Their work, as first outlined,
consisted merely in visiting the hospital. Four
members were to go daily in rotation and ask
permission of the Augustinian Sisters to help
them in their wards. From this developed an
extensive relief service; the ladies eventually
renting a room in the vicinity of the hospital where
they prepared special diets and made garments
and comforts for the sick, and these supplies were
regularly distributed. Allied interests crowded
rapidly upon them, and the assembly, somewhat
after the fashion of the modern women's club,
soon took up various departments of work. A
prominent and very successful section devoted
itself more especially to work among prisoners.
Another section was charged with rescue work
among young girls ; another took care of a hospice
for aged couples. But above all other interests
came the care of foundlings, so closely associated
with the name of St. Vincent de Paul. Charlotte
de Ligny, a friend of Mme. de Goussault, gave
the association a house and supported it at her

414 A History of Nursing

own expense. This work began in 1634. Vin-
cent, as was always his custom, was not desirous
of ruling or holding a prominent place; he made
no demands, asked the women's advice, brought
them information about cases, and kept careful
notes of points for investigation : ' whether that
man has anything to live on ; has he children, and
how many?' But in their regular meetings he
electrified and melted the most worldly by his
simple and touching addresses. It was by his
advice, too, that the members met at one an-
other's houses in different parts of Paris, in order
to reach more people than would come to one
place. ' Lay off your jewels and fine clothing
to visit the poor,' said Vincent, "and treat them
openly, respectfully, and as persons of quality,
avoiding all familiarity or stiffness. To send
money is good, but we have not really begun to
serve the poor until we visit them. " 1

The associations in the provinces were still
active, but sometimes ill-regulated or ineffective,
and Vincent sent specially able women from
Paris to make provincial tours in order that
they might stimulate, organise, or reorganise the
branches. In these towns they always visited
the hospitals, which were often in a deplorable
condition. Feillet gives a lamentable picture of
the general state of institutions at that time.
Their revenues were often corruptly turned from
their original purpose to enrich privileged persons,

1 Bougaud, of. cit., vol. i., p. 250.

Vincent de Paul's Sisters of Charity 4!5

and almost every town in France had a lawsuit
pending with some monastic order over mis-
managed property intended for the poor.1

Thus at Orleans Mad. de Goussault found the
hospital rich, but in consequence of the small
number of Sisters the patients were left to the
cafe of servants, while the hospital at Blois was
badly organised and was not visited at all. But
now the visiting work was reaching a point at
which the Dames de Charite did not cover the
whole ground, and the urgent needs of the sick
and the poor impressed themselves upon the minds
of Vincent and his aides. It was often the case
in Paris that social obligations, fear of infection,
or the husband's veto, prevented the highborn
dames from personally making their visits to the
sick, and they would send their servants to per-
form their vicarious duties. But Vincent knew
that this was but a poor and uncertain method,
and that the work would certainly suffer unless
there were some specialised workers, of humbler
grade perhaps, but more reliable. In the pro-
vinces and rural districts the women did their
duty faithfully, but in the capital many were
not to be depended upon. He pointed out
that the towns and villages were full of good,
simple girls not inclined to convent life and
not all likely to marry; that he himself knew
hundreds such; why could not they help in

1 La Misere QU temps de la Fronde, Paris, 1862, pp. 214-
216.

4i 6 A History of Nursing

this work? Soon he had certain ones ap-
pointed to certain parishes. They at first lodged
with the Dames de Charite and visited the
poor and the sick during the week, meeting
on Sunday in the church of Saint Lazare to hear
a discourse from Vincent dealing with their duties.
So informal and so natural was the advent of the
Sister of Charity. "Oh, mon Dieu!' said Vin-
cent afterwards, " How can it be said that I
founded the Sisters of Charity? I did not even
think of it, nor did Mile, le Gras. "* It is possible
that Vincent's humility on this point does not do
full justice either to himself or to his noble co-
worker, to whose share in creating the Sisters
of Charity we must now turn. It does not seem
quite certain that Mile, le Gras had never thought
of what might be done along such lines, though
doubtless neither of these two unselfish workers
ever dreamed of the scope their effort might
attain.

Louise de Marillac was born in 1591, in Paris,
of good though not of noble family. Having
early lost her mother, she was taken by her
father to be reared by her aunt in the convent
at Poissy, a splendid abbey, a gem of sumptuous
architecture, grouped in buildings like a small
city and surrounded by a large estate. The abbey
had been founded in 1301, and was rich in its
associations of royal and famous nuns. The
Sisters of Poissy were deeply learned in the classics.

1 Bougaud, of. cit., vol. i., p. 266.

Vincent de Paul's Sisters of Charity 4!7

One of them, Anne de Marquest, was held to be
the foremost Greek scholar of her day, and their
young pupils were taught Greek and Latin, art
and literature. But the atmosphere was too
worldly and brilliant to please M. Marillac, who
was austere and devout. At an early age the
little girl was brought home and given private
teachers, her education being finished under her
father's care. He desired that she should be
taught "like a man, and also like a woman,'
and therefore saw to it that she was grounded in
philosophy, as a cultivation of her reason and as
an introduction to the most advanced sciences.1
He also gave her a thorough training in painting,
which she never quite abandoned. Louise was
by nature fervent and docile, inclined to austerity,
and her training had strengthened her deep piety.
When she was quite a young girl she longed to
join the Capucines, whose rule was of the se-
verest, but she was dissuaded from this step by a
wise and good Capucin father, Pere Honore, for
she was of frail physique, and he told her that
God had other purposes for her. After her father's
death her relatives persuaded her to marry, and
being of a clinging and dependent nature, she
acceded to their wishes. Her husband, Antoine
le Gras, belonged to a good and plain bourgeois
family, and therefore, as the title Madame was
only given to noble ladies, she continued to be
called Mademoiselle and has always been thus

1 Gobillon, La Vie de Mile. Legras, 1676, p. 7.

VOL. I. — 37

418 A History of Nursing

known among the Sisters. Her married life re-
calls that of St. Elizabeth. Her husband was
good and tender-hearted and kind to the poor.
Louise loved him and was happy in her domestic
cares, which she augmented by an untiring de-
votion to all the poor and sick of her neighbour-
hood. She now associated with her a group of
women, and they made visiting nursing their
chief interest. She had no fear of contagion, nor
did filth and squalor deter her from all kinds of
personal service, such as bathing those afflicted
with the plague and laying out the dead. "Al-
ready," says Gobillon,1 "as she later recorded in
writing, she had conceived the thought of a com-
pany of women to serve and nurse the poor. '
Her husband died in 1625, leaving her a com-
petence, and she then vowed herself to widowhood
and good works. Sometime after this mutual
friends made her known to Vincent, whom there-
after she steadfastly almost worshipped for his
goodness, and under whose direction she placed
herself unreservedly for practical work. He, on
his part, checked her emotional nature with wis-
dom and kindness, balanced her leanings toward
asceticism with his wholesome common-sense,
and occupied her to the full with responsible and
important duties for which her superior qualities
of mind, unbounded zeal, and fine administrative
ability fitted her. In her fervid self-renunciation
she wanted to deprive herself of her modest fortune

i Of. cit., p. 1 88.

Vincent de Paul's Sisters of Charity 419

and live a life of complete poverty, but Vincent
would not allow her to do this. " Be careful of
your health,' he wrote her, :' and be careful not
to overdo: it is a trick of the devil, by which he
deceives good souls, to entice them to do more
than they can, and so make them unable to do
anything at all. ' Again he tells her : " Be cheerful,
and do what you have to do with a bright spirit. '
Mile, le Gras rapidly became Vincent's chief
aide and co-worker in developing the organised
charities. Between 1629 and 1631 she travelled
almost constantly, supervising and directing the
work in the provinces; usually accompanied by
another lady, she went on horseback or in car-
riages from village to village. It was natural
that she should from the first have had the closest
relations with the hospital visiting, and when the
first " Filles" were selected to assist the "Dames'
it was she who gave them their practical in-
struction. As they grew in number, it was she
who first vividly realised the necessity for sys-
tematic training and uniform standards in their
duties, and she offered with ardour to devote her-
self entirely to this work, but Vincent, always
careful, waited long before taking action. It
was, however, soon evident that there must be a
central home and a directress to frame an ideal
standard and guide the young Sisters to it.
Hitherto, fresh from their villages and having
had the advantage of only a brief initiation from
Louise, they had been placed in different parishes;

420 A History of Nursing

but, little accustomed as they were to the care of
the sick, with no one to supervise them intelli-
gently, no one to advise and instruct them,
and no rules save the admonitions of Vincent and
Mile, le Gras, it is no wonder that they sometimes
failed in their duties, but rather that they did so
well. Nor were the Dames, though willing, able
to teach them methods or to bring their nursing
up to a high standard.

Finally Vincent chose a house, low and small,
with a dark hall and two little windows, and on
the 29th of November, 1633, Mile, le Gras with
four or five Sisters took possession of it. The
little house was still standing in 1894 in the Rue
Cardinal Lemoine, bearing the number 43, and
occupied as a stationer's shop. This was the
cradle of the Sisters of Charity. Louise desired
to dedicate herself by a vow to the work, and four
months after their installation in the home Vin-
cent allowed her to do so. On the 25th of March,
1634, she thus dedicated herself, and this is a
memorable day for the Sisters all over the world ;
for on this da}7, as it recurs annually, every
Sister of Charity becomes free to return to the
world, to marry, or, as most do, to renew her vows
for another year. The applicants were first
called by their baptismal names. 'As to Mar-
guerite, ' wrote Vincent in his note-book, ' it will
be well to take care of her. ' His notes on them
are homely and practical. 1 Yesterday one came

1 Bougaud, op. cit., vol. i., pp. 267-268.

-sr- yg

i de Jllao ,

ej I

fVi ChiTnl? JtTuntitrj s/Kf pan nrej nmla

i ' if

' / 7J /r / ^ , * / 1 // / « ** WOO ,

From La Vie de Demoiselle le Gras, by Gobillon, 1676

Vincent de Paul's Sisters of Charity 421

who seems very uncouth. I have not inquired
whether the one from Ardennes can read or sew;
I very much doubt whether she will be satis-
factory. ' Later on he speaks of them as Sisters.

Among these simple peasant girls were char-
acters of extraordinary force and beauty. One
of the first Sisters was Marguerite Nazeau, a
young shepherdess who had taught herself to
read by asking the passers-by, wrhen they looked
like educated people, how the letters and words
were pronounced. By the same slow, patient
methods she had learned to write, and she then
collected all the children of the village and taught
them all that she had learned. Later, obeying
an impulse that she perhaps could not have
defined, she began to travel from village to village,
often suffering hardship and always in the face
of ridicule, teaching wherever she went. On one
of his tours Vincent met her and at once recog-
nised a rarely devoted spirit, and Marguerite,
hearing of the new work, offered herself to Mile,
le Gras. She laboured as a Sister of Charity with
great love and zeal, in three parishes, and finally
gave up her life for her patients. Finding, one
day, a woman dying of the plague upon the high
road, she took her to her own lodgings, and put
here in her own bed. The patient died, and
Marguerite, feeling her strength succumbing to
the poison of the infection, went to the hospital
St. Louis, and died there.

Vincent was determined that the Sisters should

422 A History of Nursing

not become religious in the monastic sense. He
had seen the visiting nursing order planned by
Mme. de Chantal fail of its purpose because the
clergy would not tolerate its voluntary and secular
form. He knew that the work of a visiting nurse
was absolutely incompatible with solemn vows,
enclosure, hours of religious exercises, and com-
plete subordination to the clergy. He meant his
nurses to do practical work. They already wore
the picturesque dress of the ordinary people, -
the grey-blue rough gown with the white head-
dress,— and he intended that they should remain
unaffected, willing, and ready helpers, able to go
anywhere and do anything. Wise and sagacious
man that he was, he decided to make his demon-
stration before he made his rule, and before formal
recognition of the Sisters should be sought. Pub-
lic opinion was to be educated before the ob-
jections of king, aristocracy, and church could be
modified. For nine years he taught the Sisters
his principles and views, and Mile, le Gras trained
them for their work and appointed them to it,
before he allowed any of them to promise them-
selves, even for a year, and almost twenty years
went by, and he was nearly eighty, before he gave
them a definite constitution. He said to them :

It was thought proper at first that the name Asso-
ciation should continue, fearing that if, instead of it,
you were to be called "a Congregation, there might
be some among you who in some future time would
wish to change the house into a cloister and become

Vincent de Paul's Sisters of Charity 423

a religious order as the Daughters of St. Marie have
done. . . . My daughters, you are not 'religious"
in the proper (monastic) sense, and if there should be
found some marplot among you to say ' ' It is better
to be a nun, " ah! then, my daughters, your company
will be ready for extreme unction. Fear this, my
daughters, and while you live permit no such change ;
never consent to it. Nuns must needs have a cloister,
but the Sister of Charity must go everywhere. . . .
No other monastery than the house of the sick, no
other chapel than the parish church. 1

He wished them also to retain their secular dress,
and when it was suggested that they should have
a veil, Vincent answered, ' Modesty is their veil. '
He asked them only to bind themselves by a vow
from year to year. ' Perhaps [says Bougaud]
if he had been free he would have required none and
so have allowed their devotedness full liberty. '
To warn them he said : You are not ' religious '
in the strict sense, and can never be, because of
the service of the poor. You must, therefore, be
even holier than nuns, since you have greater
temptations and less security; if you are not
truly holy you shall certainly be lost" ; and again :
You have no grating to shut you off from the
dangers of the world; you must erect one in your
own inner self, which will be far better. '

Vincent wished the Sisters to be instructed, and
in order that they might be more adapted for their

1 Life of St. Vincent de Paid, by Maynard, vol. iii., p. 246,
quoted from St. Vincent's Conferences aux Filles de la Charitc.

2 Op. cit., vol. i., p. 309.

424 A History of Nursing

work he wanted them to be able to read, write,
and do a certain amount of arithmetic. On the
medical side of their duties he was as wise and
liberal as on all others, and one can only wonder
at the short-sightedness of some of his successors
who appear to have tried, so far as possible, to
undo his work. It is possible that the French
hospitals might have had quite a different history
had the principles and sagacity of a Saint Vincent
de Paul always been present in them, and if a Mile,
le Gras had been kept at the head of the nursing
Sisters and their work. Perhaps even laicisation
itself, the logical and inevitable result of cramping
interference, might have been long delayed or even
unheard of.

You should act, my Sisters [said he], with great
respect and obedience toward the doctors, taking
great care never to condemn or contradict their orders.
Endeavour, on the contrary, to fulfil them with great
exactitude, and without ever presuming to prepare
the medicines according to your own way of thinking.
Punctually follow what they have prescribed, both
with regard to the quantity of the dose and the
ingredients of which it is composed, because upon
this fidelity and exactness depends nothing less,
perhaps, than the life of the patient. Respect the
doctors, not only because they are more learned and
enlightened than you, but because God commands
you in the Holy Scriptures to do so in the following
words: 'Honour the physicians, for the need thou
hast of them.' . . . You are ignorant of the rea-
sons they have for pursuing different methods in

Vincent de Paul's Sisters of Charity 425

the treatment of maladies which seem to you to be
the same. You must endeavour particularly to ob-
serve and remember their methods of treating the
sick, so that when you will be in the villages, or some
place where there is no doctor, you may render
yourselves useful by applying their methods. You
ought, therefore, to instruct yourself, so as to know
in what case it is necessary to bleed from the arm
or from the foot; what quantity you should take
on each occasion; when to apply the cupping-glasses.
Learn also the different remedies to be used in the
various kinds of diseases, and the proper time and
manner of administering them. All this is very
necessary for you, and you will do a great deal of
good when you are well instructed in it. I think
it very essential that you should have some con-
ferences with one another on this subject in the form
of catechism.1

Do without delay whatever regards the service of
the poor, and if, instead of making your meditation
in the morning, you have to carry the remedies to the
sick, go in contentment and peace. What a con-
solation for a good Sister of Charity to reflect and say
to herself: 'Instead of making my meditation or
spiritual reading I go to assist the sick poor who need
my care so much, and I know that this action will
be most agreeable to God." 2

1 Questions and Answers. The modern "quiz."

2 Bougaud, op. cit., vol. i., pp. 283-290, quoting from the
Conferences.

To Mile, le Gras is due the preservation of St. Vincent's
addresses to the Sisters. She, assisted by one of her aides,
took notes of them all, and wrote them out, preserving
jealously their simple eloquence and lucidity. They have

426 A History of Nursing

His fervent piety, simplicity, and loving heart,
with Mile, le Gras's devotion and able teaching and
administration, attracted numbers of applicants.
The house was soon too small, and a new one was
purchased in 1636 near the Chapel Saint Denis and
near to Vincent's abode. A short time after Mme.
de Goussault, always their stanch friend, fell ill
and died. Before her death she said to Vincent,
speaking of the Sisters: 'If you only knew how
much I think of them. Oh, they will do great
things.'' Yes," said Vincent, 'providing they
are faithful." 1

How arduous and unremitting Mile, le Gras's
task was, only those who have built up a similar
work can know. The first call to take full charge
of a hospital service came from Angers, in 1639,
and was the source of deep gratification to the
friends of the Sisters, for now the experimental
stage seemed to have passed and a solidity of or-
ganisation to be assured. The call had come as a
result of the efforts of Mme. de Goussault, who was
especially interested in the hospital and anxious
to see it benefited as the Hotel-Dieu in Paris had
been. Mile, le Gras herself conducted a group of
Sisters to the new field and stayed there three
months with them, organising, systematising, and

been printed privately and are not obtainable. See Ma-
demoiselle le Gras, by the Countess de Richemont, Paris, 1894,
from which the material relating to Mile, le Gras has been
chiefly taken, p. 301.

. ' Bougaud, op. cit., vol. i., p. 293.

Sceur de la Charite
Helvot, Les Ordres Monastiques, etc.

Vincent de Paul's Sisters of Charity 427

training them in their duties. When she finally, full
of solicitude but of hope also, left them to them-
selves, so well disciplined were they that, not long
after, they went through a siege of pestilence
in perfect order and without flinching. The regu-
lations that she drew up for their daily routine
were strict enough. Admire her goodness as we
may, one must wish she had allowed the Sisters
a little more for breakfast. They rose at four

A.M., and at six, after having had ;'a little bread
with a taste of wine, and on communion days
the odour of a little vinegar, ' ' 1 they went to the
wards, made the beds, put everything in order,
gave the medicines, and served the breakfasts.
During the day they were to be most watchful
that the patients had every care; nourishment
was to be given them at fixed hours; they were
to have drink when they were thirsty, and some-
thing fragrant and cleansing for the mouth. The
Sisters had also definite religious responsibilities
toward the patients, instruction to give, and
prayers to read in the wards. The patients were
to be ready for the night at seven o'clock, and
the Sisters retired at eight, leaving one of their
number, in turn, on duty for the night. The
regulations2 under which they were contracted to
the hospital have served as a model for many sub-
sequent nursing institutions, both of a religious
and secular character. In general discipline and

1 Richemont, op. cit., p. 172.

2 Ibid., pp. 171-174.

428 A History of Nursing

in spiritual things they remained subordinate to
the head of their order, and might in no way be
interfered with as to their rule, which obliged
them to put the care of the sick before all else.
In everything that concerned the practical work
of the hospital, they were completely under the
orders of the hospital authorities, and were bound
to rigid obedience. They alone were to have
charge of the patients, and in this no one was to be
associated with them. (This stipulation prob-
ably had reference to other Sisters, and not to
servants.) Their dress was not to be altered,
and they were not to be sent to care for patients
outside of the hospital. In the hospital, they
were responsible only to the administration; if
a nurse proved unsatisfactory the hospital could,
after a fair trial, and due notice to the Mother-
house, request a change of Sisters at the expense
of the hospital. The authorities of the hospital
were to uphold the dignity and authority of the
Sisters in the wards; they were not to reprimand
or find fault with them publicly, but if they re-
quired correction, they were to speak to them
privately. The hospital was to care for them in
illness, and in all things they were to be treated
as 'daughters of the house" and not as hirelings.
The Motherhouse reserved the right to recall
or change the Sisters at its good judgment. All
these provisions for avoiding the friction of two
authorities were most carefully thought out and
minutely specified by Mile, le Gras, who foresaw

Vincent de Paul's Sisters of Charity 429

well the difficulties that might arise between the
hospital and the Motherhouse, and after all the
details were agreed on a contract was signed in
February, 1640, binding both parties. Later a
group of Sisters was in a similar way installed in
the hospital at Nantes, where Mile, le Gras again
in person regulated and started the new system.
It seems strange, although after all it is only
the way of the world, that the Sisters sometimes
encountered opposition and even hostility. At
one time, when Mile, le Gras was taking a group
to a hospital they were turned away from an inn.
Unfriendly influences sometimes interfered with
their hospital work. Difficulties arose at Angers,
and certain members of the administrative body
imputed to the Sisters a desire to rule the house.
At Nantes so many troubles arose that Mile,
le Gras, prevented by ill-health from going herself,
sent one of her ablest Sisters, Jeanne Lepeintre,
who, instead of being able to smooth out the
difficulties in a short time, was obliged to remain
there for six years. On the one hand, the hos-
pital authorities continually violated the terms
of the contract and demanded services which the
Sisters should not have been required to give; on
the other hand, the bishops, not understanding
the nature of the Sisters' work, attempted to im-
pose the features of a strict religious order upon
them; and finally, the municipality sometimes
accused the Sisters of mismanagement and of
injuring the prestige of the hospital. During all

430 A History of Nursing

this trying period Vincent and Mile, le Gras ex-
hibited the most unwearied patience and strove
with every weapon of goodness to straighten out
the tangles. Imputing no blame to their oppo-
nents, and exhibiting no resentment, they finally
restored peace. At least forty letters of Mile,
le Gras are still in existence, written during this
trying time to Sister Jeanne Lepeintre. These
give a graphic picture of this time of difficulty,
so often duplicated in hospital history.

A different and singular disturbance nullified
the Sisters' usefulness in the hospital at Mans,
where they had been placed under hopeful aus-
pices. The rumour was spread through the village
that all postulants (probationers) who joined the
Sisters' Company were to be sent to the colonies
in Canada, and it was even whispered that, to
spread the Gospel, they were to be married there
to the Indians.1 So loud and threatening grew
the gossip that Mile, le Gras withdrew the Sisters.
M. Portail, writing to her after the event, said
of them: "Had they done nothing else here but
give an example of quiet serenity in the midst of
storms, the time and expense would not have
been wasted."2

At the end of nine years Vincent, " always prud-
ent, and an enemy of haste,'1 chose four Sisters
to make their first vow for one year. Sister
Barbe Engiboust, a farmer's daughter, and

1 Richemont, p. 219.

2 lbid.r p. 220.

Vincent de Paul's Sisters of Charity 43 l

Sister Jeanne Dallemagne were two of the four.
The names of the other two are not known for
certain, but it is thought probable that they were
Sister Anne de Geunes, who was of noble birth,
and Sister Marguerite Laurence. In 1655 Vin-
cent finally put in writing the rules under which
the Sisters had been working, and which had been
at the outset framed by Mile, le Gras and slightly
modified by himself. The applicants were to be
of respectable parentage, irreproachable charac-
ter, good health, not over twenty-eight years of
age, and must not have lived in domestic service.
Their probation time consisted of about two
months residence in a house under observation
and teaching, followed by a longer period of seven
or eight months in the seminary, where the time
was divided between manual occupations and
religious exercises.1 Five years, in all, were re-
quired, in every case, before the Sister was per-
mitted to take her first vow, but Vincent de Paul
was unwilling that this time should be called a
noviciate, because of his desire to avoid all ap-
pearance of conventual forms. They were to
be known as the servants of the sick poor; they
were not to be sisters or nuns in the strict sense;
they were not to make perpetual vows, but only
for one year at a time. They were to wear their
secular dress, and not to have special chaplains or
confessors. Mile, le Gras was to remain their
head during her life, but after that the Sisters

1 Richemont, of. cit., p. 314.

432 A History of Nursing

were to elect a superioress every three years from
among themselves, who might be re-elected once
but not oftener. The clerical head of the Sisters
was to be the Superior General of the Congregation
of the Mission. This was Mile, le Gras's earnest
plea and she persuaded Vincent to make this
request, which Cardinal de Retz granted. Even
already there had been in various quarters much
opposition to and disapprobation of the freedom
and flexibility of the system on which the Sisters
were established. But now, fortunately, they
had made themselves so indispensable in this
twenty years of demonstration, that to unmake
them would have been an absurdity and an im-
possibility. Even as the Beguines, four hundred
years before, had firmly intrenched themselves in
the favour of the people by their practical, useful
lives, so by this time the Sisters of Charity had
made themselves secure in the hearts of all who
had witnessed their devotion and skill. In these
twenty years they had multiplied to fifty Mother-
houses, and their services were sought for from all
sides. The bishops of all the large cities wanted
them for parish and nursing work. They had practi-
cally everywhere replaced the Ladies of Charity,
some of whom had entered the order, and they had
been called to Poland and Madagascar. In spite of
all conservative opposition they were clamoured
for in the hospitals of many provincial cities, and
finally were placed in five or six of the large hos-
pitals of Paris. St. Vincent's joy and gratitude

Vincent de Paul's Sisters of Charity 433

were unbounded. The ministrations to the galley-
slaves, which had until now been undertaken by
the Dames de Charite, were also given over to
the Sisters, and the care of the foundlings, which
had been growing in extent until the great Found-
ling hospital had been established, would long
since have died out had not the Sisters been ready
to devote themselves to it. In 1645, at the re-
quest of the Bureau des Pauvres Mile, le Gras
had taken charge of the P elites Maisons, — the
asylums for the insane.1 Now, too, the Sisters
began that fearless and merciful service in the
battle-field which has endeared them so especially
to the French nation and which has brought
them military honours and homage. They were
called to Sedan in 1654 and to Arras in 1656.
' O Sisters, " said Vincent, "men go to war to kill
one another, and you go to repair the evils which
they have done. Men kill the body, and very
often the soul, and you, you go to restore life, or
at least by your care to assist in preserving it ! " 2
The remaining years of Mile, le Gras were spent
in extending and strengthening her army of
workers, for whom so many calls came now that
she was unable to meet them. Not the least ad-
mirable of her gifts was the economical ability
with which she conducted the financial affairs of
the community, for, although the Sisters brought
no dowry, in all the extensions of their activity

1 Richemont, op. cit., p. 236-238.

2 Bougaud, op. cit., vol. ii., p. 115.

Vol. I.— 28

434 A Plistory of Nursing

there was no debt, and the business basis was
sound and stable. Her remarkable ability as
an administrator wras supplemented by an unusual
insight into character — that necessary quality
of a leader. So keen was her perception in judg-
ing human nature that she herself regarded it as
a fault, as leading to a too critical severity of
judgment. But many prominent men availed
themselves of her acuteness in this respect to ask
her advice. In appearance Mile, le Gras was
rather tall, with regular features, and an air of
graciousness and unconscious dignity. By nature
fervent and ardent, she accused herself of im-
pulsiveness, but the Sisters loved this quality in her
for the enthusiasm it gave her whenever they had
anything encouraging to report. Most fortun-
ate for the work was it that Vincent's temper-
ament was always so moderate and sane. By
his influence she overcame a natural inclination
to sternness and appeared always 'simple, gay,
and cordial. ' Thus that union of strength with
sweetness was impressed upon the Sisters which
has remained stamped upon them. The teachings
of both Vincent and Mile, le Gras reiterated con-
stantly this ideal. They were to be strong and
stout of heart, of a courage that acknowledged no
difficulty, but of a suave and gentle demeanour.
No constraint or affectation was to appear in their
manner ; they were not to go about with eyes entire-
ly cast down, lest this might repel some to whom
they were sent, and Vincent de Paul told them that

Sisters of Charity Dressing a Surgical Case
Les Edifices Hospitaliers^ C. Toilet, 1892

Vincent de Paul's Sisters of Chanty 435

they would do their patients the greatest good by
a manner of modest gayety. Serenity of visage,
smiles and kindly words, a readiness to oblige and
to receive suggestions from one another, were the
qualities held up for their imitation. ' Our dear
virtue, cordiality,' wrote Mile, le Gras to Sister
Jeanne Lepeintre, and the trio of admirable char-
acteristics were "confidence, simplicity, cordial-
ity. " 1 Poverty and humility were also to Vincent
and Mile, le Gras of fundamental importance,
and she was most anxious that this character of
frugality should be maintained by the community
after her death. " For the company to survive
it must remain in all things poor and humble,'
she wrote. Naturally, for each sister remaining
in the order, a life-long maintenance, with loving
care in sickness and death, was assured. Mile, le
Gras died in March, 1660, and Vincent de Paul
survived her only until September of the same
year.2

All of the saint's greatest works of organisation
and reform (many of which, as being outside the
scope of this study, we have not even mentioned)
had been undertaken after he was fifty years of
age, and it was said of him, "This man, who was
to do so much, never hurried. ' Like other great
teachers, the principles which he laid down are as

1 La Vie de Mile, le Gras, by Gobillon, 1676.

2 The house where Vincent was born is still to be seen at
Dax, in the Department of Landes, and the parish church at
pony is full of his relics Bougaud, op. cit., vol. i., p. 5.

436 A History of Nursing

fresh and true to-day as when he spoke and wrote,
nor has society gone far beyond his conceptions
of social reform. He held that it should be pos-
sible to abolish poverty. In a well-organised
town or city there should be no poor. The pro-
tection of children also occupied a large part of
his attention. They shall see that the children
go to school, ' he said. To avoid the separation
of caste, to visit and know others through personal
interest- -these were his rock principles. That
his ideas were actually revolutionary is indicated
by M. Feillet (La Miser e an temps de la Fronde,
p. 53), who points out that, in the society of that
day, misery and poverty were regarded as punish-
ments for original sin and it was considered impious
to interfere with them. The only permissible
alleviation was through the charity of the rich,
and resignation (on the part of the sufferers) was
taught as a religious duty by those more fortu-
nately situated. The best-known and most beau-
tiful of his words relating to the Sisters are even
as yet not too well known, and will bear constant
repetition :

Their convent must be the houses of the sick; their
cell the chamber of suffering; their chapel the parish
church; their cloister the streets of the city or the
wards of hospitals; in place of the rule which binds
nuns to the one enclosure there must be the general
vow of obedience; the grating through which they
speak to others must be the fear of God; the veil
which shuts out the world must be holy modesty.

Vincent de Paul's Sisters of Charity 437

The subsequent history of the 'Filles de la
Charite ' ' has been marked by an almost unbroken
growth and activity. The days of the Revolution
were hard for them, and a branch called the
Sceurs de St. Vincent de Paul separated from the
Filles de la Charite, but Sister Duleau, who was
then at the head, displayed consummate general-
ship and courage, and brought the scattered
communities together again. The consular gov-
ernment in 1 80 1 passed a decree friendly to them,
and restored some of their departments of
work.

Thus we read that "Citizeness Duleau, formerly
superintendent of the Sisters of Charity, is author-
ised to educate girls for the care of the sick in
hospitals. ' The Sisters were close to the hearts
of the people, and their services were indispensable.
They recovered rapidly from the storm, and long
remained the most popular nursing order in
France.

Their fame and activity as nursing Sisters
reached the zenith by the latter part of the
eighteenth or the early decades of the nineteenth
century and thereafter gradually declined, though
in other lines of work, in skilled institutional
management and administration, they are still
prominent and efficient. But not all of the suc-
cessors of St. Vincent were as enlightened as he,
and the Sisters have not been allowed to share
in the advance of medical science, which has been
so rapid and brilliant since the end of the

438 A History of Nursing

eighteenth century. Successive clerical heads of
theContinent have narrowed, instead of expanding,
their nursing education, and many details of
practical nursing work are forbidden to them.
They are not allowed to witness childbirth, or
to be present at gynecological examinations, or
to nurse parturient women; they are not per-
mitted to care for venereal cases or to take the
full charge of men patients. To such an extent
is this idea carried from the standpoint of a lay
sense of propriety that they are not even allowed
to diaper the little boy babies in the foundling
hospitals, which have so long been their special
pride and centres of devotion. As a natural result
of conservatism they have lost much of their,
adaptability to general hospital work. In 1808
they supplied the nursing in France in two hun-
red and fifty hospitals. In 1893 the process of
laicisation had reduced this number to one hun-
dred and forty-seven, and in 1899 to ninety-six.1
We are, it is true, not absolutely certain that their
nursing duties were not similarly restricted in the
time of Mile, le Gras, but in that day all nursing,
and medicine itself, was elementary. If it be the
case that the foundress of the Sisters thought it
proper that a nurse should be restricted according
to the ideas of delicacy or prudery of that time,
at least later leaders have erred in not perceiving
the necessity, to a nurse, of following closely in
the footsteps of medical discovery. This, we

i Dr. Anna Hamilton, Les Gardes-Malades, p. 35.

Vincent de Paul's Sisters of Chanty 439

know, Vincent de Paul, according to the lights
of his time, perceived and held.

At the time of Sister Duleau's death there were
250 asylums and hospitals under her direction,
She must have been a woman of rare executive
ability and energy, and one of whom nursing
history knows too little. Bonaparte made much
of the "Filles," and his mother presided at meet-
ings held in 1807 at which the heads of all
the Sisters' establishments were assembled. The
Restoration saw them greatly developed, and in
1847 M- 1'Abbe Etienne gave the following fig-
ures : l The Sisters then numbered between six
and seven thousand, and there were nearly six
hundred houses under their care in France, Poland,
Galicia, Prussia, Spain, Italy, Turkey, and Asia
Minor. The Motherhouse in Paris had about
270 novices, and smaller Motherhouses had been
founded in Turin and Madrid. The order was
introduced into the United States by Mrs. Seton
in 1808, at Emmettsburg, Md. It was extended
to Philadelphia in 1814, and to New York in 1817.
In 1894 the Sisters were to be found in twenty-
four countries of the globe, and served or directed
in all, 1977 institutions. In America, they, as
also other Catholic nursing orders, have recog-
nised and accommodated themselves to the de-
mands of modern medical science by establishing
schools for secular nurses in the hospitals under
their management.

1 Maynard, op. cit.t pp. 99-116.

440 A History of Nursing

A picturesque incident of the last century illus-
trates the position of the Sister of Charity in the
French army. In 1889 Sister Maria Theresa was
presented with the Ribbon of the Legion of
Honour, and the general in command addressed
her in the presence of the troops as follows :

Sister Maria Theresa:- -You were only twenty
years of age when you first gave your services to the
wounded at Balaclava, and you were wounded in the
execution of your duty. You were again wounded
at Magenta. You bravely nursed the wounded
through all our wars in Syria, China, and Mexico.
You were carried off the field at Worth, and before
you had recovered from your injuries you were again
performing your duties. When a grenade fell into
your ambulance you without hesitation took it in
your hands and carried it to a distance of a hundred
yards, when it exploded, wounding you severely.
No soldier has ever performed his duty more heroically
than you have done, or lived more successfully for his
comrades and his country. I have the honour to pre-
sent you, in the name of France and the French Army,
with the cross which is conferred only on those who
have shown remarkable bravery in action. Soldiers
-Present arms!

In all more than thirty nurses, most of whom
were Sisters of Charity, have received the deco-
ration of the Legion of Honour in France. The
first of these was Sister Martha, who was deco-
rated in 1815, by order of Bonaparte.

CHAPTER XII

EARLY ENGLISH NURSING

IN all probability the family nursing of the
humble folk of Great Britain centuries
ago, when the first missionaries landed on her
shores, was of a grade somewhat similar to that
found to-day by the Queen's Jubilee Nurses in the
Irish bogs, or in the wild, out-of-the-world, rocky
eyries of the islands of the coast, where, with
chimneyless cabins, earthen floors, and the com-
panionship of all the domestic animals, every ex-
perience of life and death is passed through in
turn. Under such circumstances, though affec-
tion may not have been absent, there could have
been no nursing but that of nature, for so it is
to-day in the primitive corners of the earth where
unchanged customs show the habits of past ages.
The rude surgery of primitive man had made some
headway, but no trace of medical science higher
than folk-lore was to be found, for the wisdom of
the Druids, whom Toilet called the ' depositories
of all science,"1 had vanished away. With the
coming of the monasteries there dawned a more

1 De r Assistance publique, C. Toilet, p. 3.

441

442 A History of Nursing

orderly existence, with ideas of social amenit}7,
personal dignity, decency, and privacy; work,
leisure, and provision for health and sickness.
Grouped around the church as the central point
arose the cloister, refectory, kitchen, chapter-
house, dormitory, guest-house, parlour, almonry,
and library of the community, and among these
the infirmary always held an important place as a
part of the convent proper. According to Gas-
quet ! no fixed location was assigned to the in-
firmary. At Worcester it faced the west front
of the church; at Durham and Rochester it joined
it; at Norwich and Gloucester it was parallel to
the refectory. It was sometimes surrounded
by little cloisters, and often most fitly opened
on the garden filled with sweet and medicinal
herbs.2 The superior of every religious house
held it his special responsibility to provide for the
care of the sick, and he himself always made
rounds among them once a day. ' Let the abbot
take special care that they be not neglected,"
wrote Benedict in his rule, 'that they have
what they require at the hands of the cellarer. '
A special officer, called the infirmarian, was ap-
pointed to care for the sick, and according to the
rules there were required of him qualities similar
to those that we are familiar with in the char-
acterisation of the ideal nurse. He should have

•

1 English Monastic Life, by Abbot Gasquet, pp. 28-29.
Methuen & Co., London, 1905.

2 Ibid, p. 29.

Early English Nursing 443

the virtue of patience in a pre-eminent degree.
He must be gentle and good-tempered, kind, com-
passionate to the sick, and willing, as far as
possible, to gratify their needs with affectionate
sympathy. When one of the brethren was seized
with any sickness and came to the infirmary it
was the infirmarian 's duty to bring at once the
sick man's plate, spoon, and bed, and to notify
the kitchener so that the sick man's portion
might be sent to him in the infirmary refectory. *
The infirmarian always slept in the infirmary, even
if no one was ill, in order to be always ready. It
was his duty to keep supplies of medicines and
comforts for the sick, to keep the rooms clean,
the fire burning, and to have in his closet spices
and materials for soothing or stimulating draughts
and mixtures. Strict discipline was observed as
in a hospital ward; quiet and order prevailed.2
The operation of blood-letting, which our ancestors
thought so highly of, was usually performed four
times a year, or oftener if necessary, and was one
of the functions of the infirmarian. After the
lancet had been used, a styptic was applied and
the arm bandaged . Three days of after-care were
required for convalescence from bleeding3 and the
patient was allowed to go out of church before
the others, for fear of having his arm rubbed by
walking in the ranks.

1 English Monastic Life, Gasquet, p. 85.

2 Ibid., p. 86.

3 Ibid., p. 89.

444 A History of Nursing

The kitchener was another interesting personage,
whose duties were closely related with the care
of patients. His was a highly important office,
requiring superior qualities. ' In a special man-
ner he was to see to the sick, and serve them with
food that they might fancy or relish or that was
good for them. "* What could be more attractive
than the following description of the ideal qual-
ifications for this kitchen saint of the olden time?

He should be humble at heart and not only in
word; he should possess a kindly disposition and be
lavish of pity for others; he should have a sparing
hand in supplying his own needs and a prodigal one
where others are concerned; he must ever be a con-
soler of those in affliction, a refuge to those who are
sick; he should be sober and untiring and really love
the needy, that he may assist them as a father and a
helper.2

A certain kinship of principles and of organisa-
tion between the monastery and the modern
training-school is irresistibly suggested in reading
Gasquet's delightful chapter on the ' Monastery
and Its Rulers" in English Monastic Life. What
was, one asks, the actual remote ancestry of the
school for nurses, in its ethics and etiquette, in
its dignities, responsibilities, and obediences?
Was it the military organisation, or the monastic,
or did the monastery borrow the military form
and adapt it to the more peaceful activities of

1 English Monastic Life, Gasquet, p. 81.
* Ibid., p. 82.

Brother John Walingford, Infirmarian of St. Alban's
English Monastic Life, p. 87, by Abbot Gasquet. Methuen & Co., London, 1905

Early English Nursing 445

the cloister? And has the nurse's training thus
inherited something both monastic and military?
The military ideal has often been held up as one
for the nurse to imitate, and many are fond of
comparing with hers the severe discipline, unques-
tioning obedience, and courage of the soldier.
Yet it is a question how far a profession based on
the obligation to take life should serve as an ex-
ample to one devoted to saving it.

The Benedictine monastery was equally dis-
ciplinarian,1 but its strict rule took thought for
the humanities and useful, practical work. Nor
did it fail in courage and fortitude, but these
qualities were less obtrusive than in the case of
the soldier, and were displayed chiefly when times
of pestilence and affliction ravaged society. It
would seem that, for a model to study, the gentle
dignity and sweet courtesy of manner of the
monastery might better befit a nurse than the
abrupt automatic bearing of the well-drilled
soldier. The reasoned and ethical obedience of
the Benedictine cloister, which was not to respond
to unrighteous commands, is a higher type than
the mechanical military obedience, and a brighter

1 " The governing thought of monastic life was that it was
a warfare, a militia, and a monastery a camp or barrack.
Watchfulness was to be incessant, obedience prompt and
absolute, no man was to murmur, — training as rigorous,
concert as ready, and complete subordination as fixed, ful-
filment of orders as unquestioning, as in a regiment." From
Life of St. Anselm, by Dean Church, quoted by Gasquet,
Henry VIII. and English Monasteries, vol. i., p. 16, Introd.

446 A History of Nursing

adornment to a worker in the service of health
and society. ' Obedience alone, ' said Florence
Nightingale, "is a very poor thing. That upon
which it is necessary to lay stress is intelligent
obedience." 1

The monastic system established by St. Benedict
was based entirely upon the supremacy of the abbot.
Though the Rule gives directions as to an abbot's
government and furnishes him with principles on
which to act, and binds him to carry out certain
prescriptions as to consultation with others in difficult
matters, etc., the subject is told to obey without
question or hesitation the decision of the superior. It
is of course needless to say that this obedience did
not extend to the commission of evil, even were any
such a command ever imposed. Upon this principle
of implicit obedience to authority depended the
power and success of the monastic system.2

It was not for the abbot himself, but for what,
he represented in the community, that ceremonious
forms of respect were shown him, and familiarity
was avoided: so, too, not from any thought of
himself, but of his office, was he to be

careful not to lower the dignity of his office by too
much condescending to those who might be disposed
to take advantage of his good nature; nor might
he omit to correct any want of respect manifested
toward his person. He was in this to consider his
office and not his personal inclinations. 3 . . . He

1 Notes on Nursing for the Labouring Classes, 1861, p. 86.

2 English Monastic Life, Gasquet, p, 42.
* Ibid., p. 49.

Early English Nursing 447

above all others was to be careful to keep every rule
and regulation, since it was certain that when he did
not obey, himself, he could not look for the obedience
of others. . . .

As superior, he had to stand aloof from the rest, so
as not unduly to encourage familiarity in his subjects.
He was to show no respect for persons ; not favouring
one . . . more than the other, as this could not fail
to be fatal to true observance. ... 'In giving
help he should be a father, ' says one customal ; in
giving instruction he should speak as a teacher.1

While the abbot was as a father, his first
assistant, the prior, was to occupy a position like
that of the mother of a family.2 The sub -prior
was the second assistant. The novice-master
taught the novices, who were kept somewhat apart
and under special observation. The officials, dis-
cipline, rules, and duties in the monastery of
women were the same, with the same co-ordina-
tion of all toward definite purposes in work and
achievement.

According to Gasquet little information is to be
found about the nuns of England before the Refor-
mation, but glimpses of them show nursing to have
been a constant interest among them. Many were
the notable nurses among the early convent
women, for wherever we find legends of saints who
cured miraculously it is safe to assume their nursing
and medical powers. St. Bridget of Kildare, who
miraculously healed lepers; St. Ethelberga of

1 Gasquet, op. cit., pp. 51-52.

2 Ibid., p. 54.

448 A History of Nursing

Barking, who healed the sick; Walburga, who
studied medicine to minister to the poor; Mod-
wena, the Irish saint who cured epilepsy — of their
practical ability and knowledge of drugs and
treatment we may feel certain. Old records
of the Grace- Dieu convent of Augustinian nuns
in Leicestershire, England, quoted by Gasquet,
give a charming picture of the life, " simple, hard,
yet happy," of the members of a religious settle-
ment,--their frugal housekeeping, their charities,
their teaching of young gentlewomen, their
farming and cattle-raising, their spinning and
weaving, their charities and nursing. " Out of
their small means they set aside a not insignificant
portion for the care and clothing of the sick in
their infirmary; whilst out of their income they
founded not less than eight pensions."1 In the
Wiltshire convents, we are told, 4'the young
maids were brought up at the nunneries, where
they had examples of piety, and humility, and
modesty, and obedience. Here they learned
needlework, the art of confectionery, surgery
(for anciently there were no apothecaries or
surgeons; the gentlewomen did cure their poor
neighbours), physic, writing, drawing, etc.' A
typical picture of the activities of the convent
is given in the memorial to ' the Abbess Euphe-
mia' (of the Benedictine nunnery of Wherwell,
in Hampshire) of whom it is said:

To her sisters, both in health and sickness, she
1 Gasquet, of. cit.* p. 175.

Early English Nursing 449

administered the necessities of life with piety, prud-
ence, care and honesty. . . . She with maternal
piety and careful forethought built, for the use of
both sick and sound, a new and large infirmary away
from the main buildings, and in conjunction with it
a dormitory with the necessary offices. Beneath the
infirmary she constructed a water course, through
which a stream flowed with sufficient force to carry
off all refuse that might corrupt the air. . . .1

Mother Euphemia showed an amount of energy
and ability in tearing down old and unfit buildings
and replacing them with ':< new and strong ' ' ones,
extending and improving the farms and farm
buildings, draining and excavating as well as
beautifying in all directions of her domain, which
made her seem in large affairs "to have the spirit
of a man rather than of a woman. ' A new
chapel was built under her administration, and
with it was enclosed a larger space, " adorned with
pleasant vines and trees.' A new mill; new
offices around a square court where the nuns
might walk, the whole surrounded with gardens,
vineyards, shrubberies, and a wall; new manor-
houses and farm-houses; a bell-tower "of com-
manding height and exquisite workmanship'
these were among the examples of Mother Eu-
phemia's executive ability. Such were the peace-
ful and hospitable domains that long offered the
only substitute for public hospitals and alms-
houses; for in that early period, says Kirkman

1 Gasquet, op. cit,, p. 157.

2 Ibid., p. 156.

VOL. i. — 29

45° A History of Nursing

Gray,1 there was general indifference to what is
to-day the most popular form of philanthropy f
viz. : the care of the sick. It was the general
custom of the convent to offer "such provision
daily for the people that stood in need thereof, as
sick, sore, lame, or otherwise impotent, that none
or few lacked relief in one place or another. Yea,
many of them whose revenues were sufficient
thereto made hospitals and lodgings within their
own houses, wherein they kept a number of im-
potent persons with all necessaries for them, with
persons to attend upon them.2 Inadequate as
this provision must have been, it was for several
centuries the only substitute offered for general
hospital and nursing services. It was not to the
sick as such, but to the sick poor, that the convent
opened its hospitable doors ; and until after the
sixteenth century in England the word hospital
or ' maison-dieu ' continued to mean a place
something like a modern almshouse and not solely
for the medical treatment of the sick. Moreover,
treatment, in the sense we know it, hardly existed.
The first hospitals in England date from the
tenth and eleventh centuries. Creighton men-
tions the hospital of St. Peter and St. Leonard at
York, founded in 936 A. D. by Athelstane, as the

1 A History of English Philanthropy, by B. Kirkman Gray.
King & Son, London, 1905, p. 9.

2 Gasquet, Henry VIII. and the Dissolution of the Mona-^
steries, vol. ii., p. 500, from old chronicle, quoted by Gray,
p. 10.

Early English Nursing 45 1

first known,1 and other writers have recorded
Athelstane's activity in encouraging hospital
building. The hospital at York was a great es-
tablishment for the poor, with special provision
for lepers, and there were eight Sisters on the
nursing staff. Dr. Stratton mentions St. Barthol-
omew's hospital for lepers, built in 1078 in Ro-
chester by Gundulph, the bishop. It stood on the
river Medway, and was cared for by a prior and
Brothers.2

Two hospitals were built in 1084 (say some
writers; others give the date 1070) by Lanfranc,
Archbishop of Canterbury. One of these, called
the hospital of St. John Baptist, stood by the gate
of the town, within the walls, and was a general
hospital for both men and women ' ' who were
sick in various ways. '

The other was for the so-called lepers and was
situated in the woods of Blean, a mile or so out
of the town. It was called the hospital of Her-
baldown. Lanfranc was of an Italian family, and
had the Italian hospitals in mind when he built
these two famous English institutions. The
hospital of St. Giles in the East, also called St.
Giles in the Fields, founded by Queen Matilda
in 1 10 1, long remained one of the most important

1 History of Epidemics in Britain, Creighton, Macmillan
Co., p. 87.

2 Edinburgh Med. and Surg. Journ., July, 1851, article on
"The Chatham Leper Hospital."

3 Eckenstein, op. cit., p. 289.

452 A History of Nursing

'leper' hospitals in England,1 and near by, in
the Minories, Matilda established an order of
the Poor Clares to serve in the wards. Matilda
herself took a personal share in the nursing, and,
like other royal saints, often brought the sick
into her own apartments, where, girded with
a towel (so the story goes) , she washed them and
attended to their needs.2 In 1148 Matilda
founded the hospital of St. Katherine, as a me-
morial to her two children. It was chartered by
Philippa, wife of Edward III., and to the care of
the sick within its walls there was added the
express duty of the ladies of noble birth, who
served in it, to visit and nurse the sick in their
homes. It is this ancient visiting nursing founda-
tion that has, in recent years, been taken for the
corporate ancestry of the Queen Victoria Jubilee
Nurses' Institute for district nursing.

In 1123 Rahere founded St. Bartholomew's
hospital for the relief of the poor and those sick of
any disease except small-pox. This noble and

1 It is well known that the term leprosy as used in history
and literature covers a great variety of diseases not properly
classified as true leprosy, viz., elephantiasis, lupus, and other
forms of tuberculosis. Besides these, no one can read very
far in the nursing history of the Middle Ages without sus-
pecting that a great deal of the so-called leprosy was syphilis,
and this idea is confirmed by Creighton, who, in his History
of Epidemics in Britain, states that "leprosy" included all the
Visible forms of venereal disease as well as all skin diseases.
See his chapter ii., p. 69.

2 Eckenstein, p. 290, quoting Ailred of Rievaux. Also
Creighton, op. cit., p. 83.

Early English Nursing 453

historic foundation, long one of the famous hos-
pitals of the world, had at the time of its inception
two purposes, the care of orphans as well as
the sick. St. Thomas's hospital, later made famous
by the reform of nursing on Miss Nightingale's
plan, had a similar origin.

It is hardly possible for the imagination to
picture the total absence of nursing and the dire
need for it during the plague epidemics of Eng-
land. In the year 1665 from 63,000 to 65,000
died of the plague, while small-pox habitually
caused ten per cent, of all deaths. Pestilences
occurred about once in every generation, — fate-
ful visitations of every imaginable form of filth
disease. For seven hundred years, moreover,
there was a horrible association of famine with
pestilence — the dreaded 'hunger typhus' not
unknown to more modern nations. Besant has
described with thrilling imagery the calling-
calling of the voice of the plague, trying through
centuries to teach mankind its lesson of how to
live to preserve health. It is said that Erasmus
was the first to point out the relation between
filth and disease,1 and that he refused to remain in
England on account of the filthy abodes. The
houses, damp and cold, without ventilation or
drainage invited illness, but in times of pesti-
lence stricken persons were locked in them to die

1 Dr. Cheadle, in The Nurses' Journal, Feb., 1906 ; lecture on
" The Progress of Hygiene," given before the Royal British
Nurses' Association.

454 A History of Nursing

or recover as they might. Pest-houses were
places of horrors untold, and no one went to them
except in despair. Yet the treatise written by
Thomas Lodge,1 the author and playwright, who
studied medicine, shows that one at least had a
vision and a dream of what a. model contagious
hospital might be.

It should have [he said] about fifty-six rooms, each
one furnished with two beds, that the sick might
change from one to the other. There should be a
second building for convalescents. The chamber
may be sprinkled with rose vinegar or rose water if
the patient be rich; should likewise be strewn with
odoriferous flowers and sweet smelling herbs, namely,
in summer time with roses, violets and pinks, — with
leaves of willow and the vine. It is good also to have
quinces and citrons to smell to. It will comfort and
quicken the patient's heart if he rub his nose, ears,
hands, and face with a preparation of white rose
vinegar, good Malmsey wine, powder of zodoaric,
cloves, dried roses, and musk.2

Ignorance of the true nature of disease was
widespread to a late period. Superstition kept
a firm hold on men's minds (though the first
Sanitary Act of the English Parliament was passed
in 1388), and as, in the slow transition of ages,
the healing god had given place to the healing
saint, now the saint was sometimes displaced by
the king. For a long time the 'king's touch'
was supposed to cure the 'king's evil' or :cscro-

1 A Treatise on the Plague, by Thomas Lodge (1558-1625).

2 Quoted by Kirkman Gray, Hist. Engl. Philan., p. 45.

Early English Nursing 455

fula. " * Charles II. " touched " some 92,000 persons,
one of whom was no less intellectual a man than
Samuel Johnson. Even in the hospitals, to
which we must turn to find the gradual develop-
ment of modern nursing, anxiety for the patient's
soul often quite overbalanced the care for his
body.

Of the now great and famous English hospitals
the most ancient is St. Bartholomew. It is also
the richest in historical association and in medical
tradition, even as it still stands to-day foremost
in liberal intelligence of science, gracious charity,
and nursing standards of exceptional distinction.
Like the Santo Spirito in Rome, it has a legend
turning upon the dream myth intertwined with
its history. Rahere, a courtier of Henry I. whose
life had perhaps been even more than rollicking
and whose spirits were such that he has been
spoken of as the King's jester, but who had under
the jests a deeper and more serious aspiration,
became later in life a prebendary of St. Paul's
cathedral and made a religious pilgrimage to
Rome, to atone for his sins. While there he be-
came a canon regular of St. Augustine. During
his stay in the Holy City he had an attack of
Roman fever, and was very ill. He had gone
to inspect the new church of St. Bartholomew,
which had been built on the island in the Tiber
where the old ruins of the temple of ^Esculapius
had once stood. The ancient stone pillars of the

1 See Lecky, vol. i., chap, iii., p. 364.

456 A History of Nursing

pagan temple still remained within the church
precincts, but their prestige was gone, and some
relics of St. Bartholomew preserved there then
held the reverent attention of pilgrims. In his
delirium Rahere dreamed or imagined that he saw
the saint appear to him. He had already vowed
to build a hospital if he might recover and return
to England, and the vision made known to him
the site on which he should build it — a spot that
Edward the Confessor had once dreamed of for
a church. Rahere recovered,1 went home, and
told his vision. He was greatly helped with
money and land by the Bishop of London, Richard
de Belmeis, and also secured grants of privileges
from the King. He built his hospital in 1123, in
Smithfield, and at first devoted himself to its
service. In connection with it he built a priory, of
which he became the first prior. No grant or
deed is recorded before 1133, when a charter
of Henry I. recites the privileges and liberties
bestowed upon the hospital and priory, beginning :

Know ye that I have granted ... to the church
of the blessed Bartholomew of London and to Raherus
the prior and the regular canons .... and to the poor
of the hospital of the said church . . ,2 [etc.].

The hospital was to receive poor and diseased
persons 'until they got well," and pregnant

1 Histor. Sketch of the Priory and Royal Hosp. St. Bar-
tholomew. W. A. Delamotte.

s Memoranda, References, and Documents Relating to the
Royal Hospitals of London. 1836.

Gats of St. Bartholomew's Hospital

Crypt of St. Bartholomew's Church

Early English Nursing 457

women, until the birth of their children: such
babes, also, if their mothers died leaving them
unprovided for, were to be maintained until their
seventh year. Before 1137 Rahere had finished
building the greater part of the church of St.
Bartholomew, and he soon after gave up the
hospital duties and devoted himself to the
purely religious life, having established Sisters
and Brothers under the Augustinian rule to nurse
the patients in the wards.

The early buildings of the hospital were small
and were grouped about and connected with a
great hall in wThich probably most of the beds
stood.1 Here was a noble fireplace where the
King's logs were burned later, when King Henry
had sent his gift of ' one old oak" according to the
quaint records of his directions to his foresters:
' We command you to give to the patients of the
Hospital of St. Bartholomew in London as our
gift one old oak from our forest of Windsor." 2

The domain of the ancient hospital must have
been a picturesque spot in the reign of Henry VI.
Beside the hospital proper there were grouped on
it the dwellings of the Brothers and Sisters, and
also private dwelling houses and shops which were
rented out, and apparently constituted quite a
source of revenue. Lady Johanna Astley, who
had been the nurse of King Henry VI. in his in-

1 The Past and Present State of St. Bartholomew's Hospital,
by Dr. Norman Moore, p. 18. Adlard and Son, 1895.

2 Ibid., same page.

458 A History of Nursing

fancy, lived in one of these houses. A couple of
the shops were owned by Sister Emma Clunbury,
who received the rent for them, while the Master
of the house received one rose for each building. l
Few details have come down to us of the Augus-
tinian nursing sisterhood and brotherhood of St.
Bartholomew's hospital. Rahere had established
eight Brothers and four Sisters, under the Master.
Dr. Norman Moore, who knows more of the history
of the hospital than any one, once told the twenti-
eth century Sisters that the first recorded appli-
cation for a Sister's post came in the reign of
Richard Coeur de Lion, from a lady living in
Friar Street, but that it is not known whether
the Brothers accepted her.2 The first one ap-
pointed (he added) of whom record remains was
Edina de Rittle, of Essex, whose father was a
feudal lord, and who carried a large dowry with
her for the benefit of the hospital. The same
authority tells us that in the archives of the
hospital a document over seven hundred years
old, with its seal in perfect preservation, gives
the oldest list of the staff which is in existence.
Four brothers are there mentioned by name:
Elia, Walter of Hat field, Osbert of Campenden,
and Ralph the Red. Their duties, moreover,
are specified as being under three heads:

1 "The Inhabitants of St. Bartholomew's Hospital in the
Reign of Henry VI." Dr. Norman Moore, St. Bartholomew's
Journal, Sept., 1905, pp. 174-175.

2 British Journal of Nursing, May 5, 1906, p. 360.

Early English Nursing 459

medical treatment, prayer, and financial man-
agement. 1

In reading these annals of the past one cannot
but wonder at the greater simplicity of hospital
record keeping in the olden days. St. Bartholo-
mew's hospital, better managed than the Hotel-
Dieu, kept its records of cases, and an extract
from those of the sixteenth century runs as
follows :

There have been healed of the pocques, fystules,
filthie blaynes and sores to the nombre of eight hun-
dred and thence safe delivered, that other having nede
myghte entre in their roume. Beside eyght skore
and twelve that have there forsaken this life in their
intolerable miseries and griefes whiche else might have
died and stoncke on the eyes and noses of the citie.2

The suppression of the monasteries, whatever
its significance in affairs of state, was followed
by a time of hardship and sorrow for the sick poor,
Gray, while recognising fully the fact that alms-
giving creates as well as relieves dependency,
says :3

In the period following the dissolution of the monas-
teries there was a very grave increase of poverty,
matched by a corresponding decrease in the available

' " The Foundation of St. Bartholomew's Hospital," by
Norman Moore. Monthly Paper of the Guild of St. Barnabas,
London, No. 14, vol. ii., Sept.. 1884.

2 The Past and Present State of St. Bartholomew's Hospital,
Norman Moore, M.D., (Adlard and Son, London, 1895),
PP- 53-54-

3 History of English Philanthropy, p. 12.

460 A History of Nursing

means of relief; under the old system the poor
had been in some sort considered — under the new
they were grievously oppressed.

State aid and private philanthropy advanced
but slowly to fill the void, and the art of nursing
sank into a state of neglect which was to last for
over two centuries.

The demand for a secular and public control for
a number of the more important London hos-
pitals came into existence in 1538, for at this time
the mayor, aldermen, and commons of London
petitioned the king, asking that the mayor and
other officials might have the management of St.
Mary's, St. Bartholomew's, and St. Thomas's hos-
pitals,1 with others less notable from a nursing
standpoint. The suppression of the convents
and the expulsion of the religious nursing Sisters
from the hospitals necessitated replacing them
with ordinary lay servants or attendants, and
must have been a process precisely similar to the
laicisation which has taken place so energetically
in France in the last fewr decades. The English
city fathers, however, showed more practical
wisdom than the French in one important respect ;
they copied the hierarchy of the religious orders
and placed a matron at the head of all the women.
They also retained the title ' Sister, ' with its
associations of kindness and consolation, for the
nurses in charge of wards, and thus they pre-

1 Mem. Ref. and Documents relating to the Royal Hospitals.
1836.

Early English Nursing 461

served the form best adapted to lend itself to
the new spirit of education and teaching which
it was later destined to meet.

The hospital of St. Bartholomew reverted to
the city in 1547, the agreement made then be-
tween the king and the mayor reciting that the
city should have forever the Hospital of Little St.
Bartholomew, and that it should be called "The
House of the Poor in West Smithfield in the
suburbs of the City of London of King Henry the
Eighth's foundation"; that there should be a
priest called the vicar and another the hospitaller ;
that room should be prepared for one hundred poor
men and women, and for a matron with twelve
women under her to make the beds and attend
to the said men and women.1

There was to be one physician, one surgeon, and
eight "byddles' or beadles to bring to the said
hospital such poor, sick, aged, and impotent per-
sons as should be found going about the city
and suburbs. This regulation sounds as if the
hospital were now something of an almshouse,
and the 'byddles' seem to have been a later
order of the 'parabolani' of earlier times. In
this same year, 1547, the citizens also acquired
Bethlehem,2 an asylum for insane patients, and
the then abandoned hospital of St. Thomas, and
fitted up, also for ' poor, impotent, lame, and
diseased' persons, the institution which was

1 Mem. Ref. and Doc.

2 Whence the word "Bedlam" as applied to madhouses.

462 A History of Nursing

later, in new and imposing buildings, to become
famous as the home of the Nightingale School.
The historic St. Thomas's, in which one of the
greatest reforms of the nineteenth century was
wrought by a woman, owed its earliest origin
likewise to a woman, for a pious dame named
Mary, a ferry-boat keeper, soon after the Con-
quest, had given the original site for a convent.
This Mary was canonised as St. Mary Overie
(over the river) . In 1 2 1 2 the convent was burned,
but rebuilt the next year, by Richard, prior of
Bermondsey, as an almonry for poor children.
Later, at a date somewhat uncertain, the bishop
of Winchester built a hospital there and estab-
lished a Master, Brethren, and Sisters to nurse
the poor. After the Reformation it passed into
the hands of the city. At that time it had about
forty beds. In 1732, St. Thomas's was rebuilt,
and the nursing system, adapted from that of the
old orders, gave a Sister (secular) to each ward with
two or three servant nurses under her. In 1871
the stately new pavilions which now ornament
the banks of the Thames were completed, in-
cluding the beautiful Nightingale Home and
Training School.

The city authorities, when they took charge,
framed rules for the government of all their hos-
pitals, called the " Order of the Hospital, "' and in
these rules the regulations prescribing the duties
of the various officials were set forth as " Charges,"

1 Mem. Ref, and Doc.

Early English Nursing 463

and now make quaint and interesting reading.
At stated fixed times these regulations were read
aloud in the hospitals before all of those whom
they concerned. Of special interest to nurses are
those from which the following extracts are
taken :

The Matron's Charge:

. . . Your charge is also to search and enquire
whether the women doe their duetie, in washing of
the children's sheets and shirts, and in keeping cleane
and sweet those that are committed to their charge;
and also in the beddes, sheets, coverlets, and ap-
paraile (with keping clean their wards and chambers)
mending of such as shalbe broken from time to time.
And especially yow shall geue diligent heede, that
the said washers and nurses of this howse be alwaies
well occupied and not idle. . . . You shal also once
in every quarter of the yeare examine the inventorie
which shalbe delivered unto you, of the implements
of the howse; as of beddes, bolsters, mattrasses, blan-
quets, coverlets, shets, pallads, shirts, hosen, and
such other; whether any of the same be purloyned,
embezeled, spoiled or otherwise consumed; and to
make such lacke and faults, as by yow shalbe espied,
knowen unto the almoners of this howse for the time
being. . . . You shall twise or thrise in euery weke
arise in the night, and goe as well into the sick warde
as also into euery other warde, and there se that the
children be couered in the beddes, wherby they take
no cold. . . .

Of somewhat later date is the rule following :
Also at such times as the Sisters shall not be oc-

464 A History of Nursing

cupied about the poor, ye shall set them to spinning,
or doing of some other manner of work that may
avoid idleness and be profitable to the poor of this
house. Also ye shall receive the flax provided by the
Governeurs of this House and the same being spun
by the Sisters ye shall commit to the said Governeurs
that they may both put order for the weighing of the
same to weaver, and for the measuring of it at the
returning thereof.

Year 1557.

The Charge of the Nurses and Keepers of the
Wardes :

... Ye shall also flie and eschue all rayling,
skoldinge, swearinge, and drunkenness.

Ye shall in your behauiour and doings be vertuous,
louinge, and diligent.

Ye shall also carefully and diligently oversee, keepe,
and governe all those tender babes and younglings
that shalbe committed to your charge, and the same
holesomely, cleanely, and sweetly noorishe and bring
up. . . .

The year 1580.

Ye shall also faithfully and charitably serve and
help the poor in all their griefs and diseases as well
by keeping them sweet and clean as in giving them
their meats and drinks after the most honest and
comfortable manner. . . . Also ye shall use unto
them good and honest talk such as may comfort and
amend them . . . and above all things see that ye
avoid, abhor, and detest scoldings and drunkenness,
as most pestilent and filthy vices. . . .

To visit the patients in the wards was the duty

Early English Nursing 465

of the hospitaller, and not, apparently, strange
as it seems, of the physicians: the latter, judging
by the old regulations, seem to have inspected
the patients about once a week, the occasion
being one of great state and ceremony. This
appears in the "Charge' to the physician of St.
Bartholomew's Hospital, which on Oct. 14, 1609,
reads thus :

Physician :

You are here elected and admitted to be the physi-
cian for the Poor of this Hospital to perform the Charge
following. That is to say, first day in the week at
the least through the year or oftener as need shall
require you shall come to this hospital and cause the
Hospital Matron or Porter to call before you in the
hall of this hospital such and so many of the poor
harboured in this hospital as shall need the counsel
and advice of the physician . . . writing in a book
appointed for that purpose such medicines with their
compounds and necessaries as appertaineth to the
apothecary of this house to be provided and made
ready for to be ministered unto the poor, any one in
particular according to his disease.

Among the many famous medical chiefs of St.
Bartholomew's was William Harvey, and we may
imagine him in his imposing ruff, sitting in dig- >
nified state at a table in the great hall, while the
patients, brought in from the wards, sat on a
settle near him, the apothecary, ste\vard, and
matron all standing at attention near by, while
he gave his orders. A prescription book which was

VOL. I. — 30

466 A History of Nursing

kept for the physician to write his orders in was
always kept under lock and key.1

The old hall of the hospital was pulled down
about 1728, and a magnificent new one, hung
with many portraits to commemorate the greatness
of the past, is now one of the sights of London.

Equally curious were the rules of earlier times
in St. Thomas's Hospital. Thus, under the head-
ing of The Duty of the Sister, " we find the rules
enact that they

be careful there be no playing at cards, dice, or any
other games in this house, to give notice to the treas-
urer or steward, if any offend therein.

That they wash, or cause to be washed, all weak
people's clouts, without taking money or reward for
the same. That they give the medicines as directed ;
the night medicines by eight o'clock in winter, and
nine in summer.

That they appoint some sober patient to crave a
blessing and return thanks at every meal; to read
at the desk on Sunday, and the rules and orders to be
observed by the patients to be read aloud in the
ward every Friday morning.

As to "the duty of the nurse/ what would
nurses of the present day think of the following
rules?

She must stupe as often, and in such manner, all
such patients as the doctors and surgeons shall direct,
and attend the working of all the vomits.

She is to make all the beds on one side of the ward,

1 William Harvey, by D'Arcy Power, New York, 1898.

Early English Nursing 467

and to scour and make clean the beds and floors of
the whole ward with the tables and forms, the passage
and stairs, and garrets; to assist her, she may take
such patients as the sisters shall think fit and able to
help her. She must keep clean scoured the cans for
beer, the broth pails, pans, platters, and plates, etc.,
fouled at dinner. She must attend the butler at the
ringing of the beer-bell, and take with her such patients
as are able to carry the beer in safety to the ward,
and not suffer such patients to waste or embezzle
it by the way, but see that the cans be carried full
into the ward; and in like manner at his ringing the
bread-bell, she must attend and take the just number
of loaves for the patients, who are entitled to it; and
also at the ringing of the cook's bell, she must attend
her, and receive from her the exact quantity of
provisions that are appointed for each patient.

While the quaint language of earlier centuries
gradually became modernised, the duties of the
nurses remained as thus specified to the middle
of the nineteenth century.

Turning now from the hospitals to a survey of
private life, we find that the women of England
were as charitable as those of any country and as
active in visiting nursing. There are records of a
Lady Warwick who, in the estimation of her
contemporaries, was an able physician. She
took destitute patients into her house for treat-
ment and nursing and had a great reputation for
curing diseases and dressing wounds. There was
also a Countess of Arundel who maintained a
hospital for the sick poor in her own house, and

468 A History of Nursing

whose energy in prescribing was such that "three
score dozen' sheepskins were used in one year
to make the plasters which she gave away.1
Innumerable were the women who thus responded
to the needs of the sick, and whose voluntary
services to a certain degree filled the place in
public usefulness now occupied by the hospital
and the dispensary. To-day, the hospital in the
private country house or castle is not to be found ;
wounds and sores are seldom seen by well-to-do
people; only the family medicine closet and supply
of flannels of the olden times remain in rural
regions, except in some remoter localities where
such a closet as that of Catharine Elsmere may be
found. The Rev. Mr. Colfe of Lewisham had a
wonderful wife, who died in 1643. ^n ner epitaph
her husband wrote: "Above forty years a willing
nurse, midwife, surgeon and, in part, physician,
to all, both rich and poor, without expecting
reward. "2

In 1782 we find a rudimentary attempt at the
'cottage nursing' now so dear to the hearts
df English philanthropists. The Rev. Mr. Dolling,
vicar of Aldenham, raised subscriptions to send
women to London hospitals for three months'
training in midwifery, that they might then
work among the women of the village. Other

1 Ladies of the Seventeenth Century. By the author of
Magdalen Stafford.

2 History of English Philanthropy, by B. Kirkman Gray,
London, 1905, p. 48.

Early English Nursing 469

villages copied this example, and some furnished
maternity bags as well, while one parish pro-
vided bed-linen, gowns, " a large easy wicker-chair,
with a head to it, ' and a candlestick with a
pannikin attached 'for heating liquid in."1

The eighteenth century saw the building of a
great number of public hospitals. Dr. Steele,
in a paper on " Mortality in Hospitals," mentions
by name fifty of the most important existing
hospitals as dating from that century. And it
was time, for Gray says2 that at the beginning
of the century hospital accommodation scarcely
existed except in London, where it was inade-
quate. Fever hospitals or contagious hospitals, as
we call them, were first built as public institutions
toxvard the close of the eighteenth century. Before
that, they had had to depend on private philan-
thropy, and wrere no doubt destitute enough as to
science. With public fever hospitals, the first
feeble glimmer of organised sanitation and pre-
vention appears, according to Gray (wrho has no
great enthusiasm for the eighteenth century), in
the prescription of whitewash. The most sig-
nificant discovery made in the whole course of
that [hospital] development was implicated in
this first dim recognition that the care of the sick
remains idle until unnecessary causes of disease
have been cut off, ' says Gray 3 ; and again ; ''The

1 History of English Philanthropy, p. 236.

2 Ibid., p. 125.

3 Ibid., p. 152.

470 A History of Nursing

discovery of whitewash is the most hopeful fact
in the philanthropic history of the century just be-
cause it points to future methods of a constructive
corporate organisation of health. ' The special
hospitals of the eighteenth century were for
venereal cases, obstetrics, lunacy, and cancer.
These latter, based on the purpose of research and
better knowledge, had the most distinctly scien-
tific character. But no evidence is given as yet
that the need of skilled nursing was felt, though
there was some expression of the need of skilled
midwifery. The very word nursing, it has been
said, is not to be found in the table of contents of
any old volume or journal, and this seems to be
verified by actual search, though the word nurse
appears occasionally for some passing mention.
The ordinary comforts of modern life were often
quite lacking in hospitals; for we find Dr. John
Gregorie in 1751 writing to the managers of the
Aberdeen hospitals on the need of bath-tubs as
follows: "Considering how useful- -yea, necessary
-hot and cold bathing are in ye cure of many
diseases, we cannot but earnestly hope to see this
plan' (viz., to have a bath-tub) ''executed."1

The latter part of the eighteenth century was
also the period when Wm. Tuke in England, and
Pinel in France, rediscovered, independently of
each other, what the Greek physicians had known

'"Nursing in Scotland," by Rachel Frances Lumsden. Hos-
pitals, Dispensaries, and Nursing Papers, read at the World's
Fair, Chicago, 1893, p. 490.

Early English Nursing 47 T

well two thousand years before, namely, the
proper kind of treatment and care of the insane.
From this time on the dawn of the idea that
chains, box-beds, strait- jackets, tortures of fright
and shock by darkness, hunger, and cold, were
not scientific or civilised methods to use with
insane patients, grew slowly, and one of the most
cruel delusions ever harboured by superstitious
man faded slowly from his mind. Tuke, who
belonged to the Society of Friends, that clear-
sighted element of mankind that has done so
much for humanity, built in his garden a retreat
where chains and terrors were replaced by kind-
ness, occupation, and the natural tonic of green
trees and grass, with little or no restraint; and
Pinel at the same time was following the same
line in France. Tuke was not a physician, but
a tea- merchant, but he employed professional
management for his merciful enterprise, always,
however, keeping it under his own control. He
must have had nurses, but who they were we do
not know. Probably, securing plain and humble
persons, he filled them with his own spirit, as Dr.
Bourne ville has done in Paris with the attendants
of his clinic for nervous patients.

About this time, too, a general hospital house-
cleaning was going on under the incisive criticisms
of Howard. Thus the Board of the Middlesex
Hospital, deeply stung by certain of his remarks
on its condition, wrote him a note with this
challenge : " The circumstances of the wards being

472 A History of Nursing

close and dirty not applying in any degree to the
real state of them, they being large, clean and
airy, [the governors] will be much honoured by
another visit from that gentleman": and then
hastily fell to painting, whitewashing, and re-
moving partitions.1

The oldest public hospital in Dublin was es-
tablished in 1720 by a woman, Madam Steevens,
who bought the land and gave the money, directed
the building, and lived in the hospital until her
death. It was for a long time named for her, but
now for some inscrutable reason it bears the name
of a physician.2

A curious custom which seems, at an early date,
to have been somewhat general, but began to be
discontinued in the eighteenth century, is men-
tioned in the records of the Middlesex hospital;
namely, the calling of the wards by the names
of the nurses who attended them. (To-day, the
custom in many English hospitals is just the re-
verse of this, the Sister in charge now being called
by the name of her ward; as Sister "Casualty.")
The old hospital records are full of quaintly ex-
pressed items, and the temptation to reproduce
them at length is a strong one. Thus we read
that in a certain hospital the servants of the
infirmary, three in number, were selected; the
servants being a ' messenger and door-keeper, '

1 History of the Middlesex Hospital during the First Century
of its Existence. Erasmus Wilson, 1845, London.

2 The British Journal of Xitrsing, Mar. 31, 1906, p. 252.

Early English Nursing 473

a matron, who was wife of the messenger, and a
nurse.

As we follow the old reports of this institution
we find that the hospital property had accumu-
lated to an extent requiring an order to be passed
"That an inventory be taken of all the goods,
linen, utensils, etc., whatsoever, belonging to this
hospital, and entered in the book, and that a copy
of the same be given to the matron . ' Certain
misdemeanours are next referred to in the occur-
rence of orders for the suspension of the apothe-
cary, messenger, and matron; and their dismissal
at the subsequent quarterly court. The apothe-
cary is stated to have committed actions " vile and
enormous, " and the messenger and matron to have
neglected their duty 'in not acquainting the
committee of several indecencies and irregulari-
ties committed by others, and consented to by
them, to the great disrepute of the hospital . ' A
proposition was also made to check misbehaviour
in the patients, the penalties being suspension
of diet at the discretion of the steward; but this
proposition was very properly negatived. Other
odd records run as follows:

That no patient be permitted to talk to anybody
in the street out of the Windows.

That no liquors be brought into the house without
leave of the stewards.

That no persons after the hour of nine do presume
to talk to one another in bed to the disturbance of the
patients except those who want assistance. . . .

474 A History of Nursing

That no more than fifteen patients be admitted
in the house at one time, so that there may always
be room to take in casualties; [and it was resolved]
that fifteen beds be the standard of this hospital for
the future, and three spare beds for accidents, until
further ordered.

. . . That such married women may be admitted
into the hospital in the last month of their pregnancy,
and that none of them shall be permitted to go out
of the hospital without her child on any pretence
whatever. . . .

That Mr. Layard be man- mid wife in ordinary to
this hospital.

That Dr. Sandys be man-midwife extraordinary
to this hospital. . . .

That no woman- midwife be permitted to act as
midwife in this hospital.

The spirit of economy showed itself in various
ways; thus, in January an order was given for
the purchase of 'twelve second-hand pewter
plates"; and in the following June another order
provided for the sale of the old clothes of the
patients who died in the hospital.

In April it was 'resolved that the temporary
women's ward be for the present shut up, and
that Eleanor Conolly, the nurse attending it, be
discharged this day. ' It was also thought proper
' to discharge one of the night nurses, on account
of the number of patients being reduced. ' And
the assistant matron was recommended to "seek
some other employment. "

Another set of reports tells how it was ordered,

Early English Nursing 475

in 1787, that "the Matron take the opinion of the
Faculty about the propriety of washing the wards
once a week. ' This having been done, the
gracious reply of the Faculty came back: " We
recommend to the Board that the wards should
continue to be washed once in every week through-
out the year, subject, however, to the discretion of
the Matron of the House to defer or omit the
same in particular wet or damp weather for any
time not exceeding one week. '

We read the following items in these minutes:

The first Matron appointed, at a salary of 15 pounds
a year, with a gratuity of 5 pounds provided she
continues a year and behaves to the satisfaction of
the Governors. . . .

Twenty beds ordered for the new Hospital. The
curtains to be of cheque linen to draw round. Feather
bolsters to be provided, but no pillows (at present).
The beds to be stuffed with Straw, Oat- flights, or
Flock. Two blankets and a "coverlid. "...

Two Night Nurses or Watchers appointed, to be
entertained in the house, — preferably to hiring such
by the night. Salary 5 pounds 5 shillings per annum.

Joseph Cole with his horse employed to raise water
from the well at one shilling an hour. . . .

(I775-) Ordered that a blue Livery Coat and
Waistcoat, a pair of Leathern Breeches, and a Hat
with a Yellow Button and Loop be procured for the
Porter. . . .

To take into consideration the Diet, and determine
whether the allowance is not too much, as a large
quantity of bread and other provisions were found

476 A History of Nursing

concealed in the several wards upon a search
made. . . .

Ordered that the present fund for the relief of
infirm and decayed Xurses being sufficient, that 2
shillings 6 pence per week be allowed to A. H. (from
the Hospital funds) who has served with credit as a
Nurse ten years in the Hospital, and is now unable
to continue her services, being lame from a disease
in the hip. The parish of - agreeing at the same
time to pay 2 shillings per week.1

Some well-directed institutions became quite
model, for that time. Howard describes thus the
county hospital at Norwich as one of the best :

Wards are lofty; there is only one floor upstairs;
bedsteads are iron, and they are not crowded. Bed,^
are straw; the furniture linen; there are no testers.
The wards are kept clean by frequent washing and
airing by the opposite windows being generally open.
There are Dutch stoves in the wards in summer and
little coppers for tea- water with which the patients are
sometimes properly indulged.

1 Extracts from The Norfolk and Norwich Hospital, 1770 to
1900, by Sir Peter Eade, M.D. London, 1900.

CHAPTER XIII

MfiDI^EVAL SURGERY AND MEDICAL TREATMENT

rr*HE specialisation of surgery as a distinct
1 branch of medical science seems to have
been attended with the same difficulties as that
of nursing, and, from the time when the Church
ceased to hold a monopoly of general medicine,
and the upward pressure of the laity and the
middle-class citizen presaged the gradual trans-
formation of medicine to a secular and scientific
profession, the surgeon has had almost as hard
a time as the nurse in attaining a recognised and
honourable position.

We are told that when the monks began to
limit their surgical practice, in accordance with the
edicts of the twelfth and thirteenth centuries,
they sent their servants, or the barbers of the
community, to perform bleeding, extraction of
teeth, and similar services, and thus arose the
craft of barber-surgeons,1

There was also a body of master- surgeons, for
St. Louis had formed a college of surgeons in 1268,

1 Curiosities of Medical Experience, J. G. Millingen, M.D.,
M.A, Richard Bentley, London, 1839, p. 288.

477

478 A History of I

in honour of St. Cosmos and The

barbers, though not belongir ore

learned body, began to enciv ;ch u; >ir

province, and to undertake ma/ i-

tions, so that presently a law wa.;
them, forbidding them to exceec
limitations unless they had been e
master-surgeon. The masters wei
better equipped than the barbers, bu
barbers were only allowed to dress b
and open wounds.

The jealousies which arose between \
and the surgical men, and the efforts
both to adjust their boundary lines ana . apt
themselves to the rapidly changing so .dl con-
ditions (not the least of which was that in 1452
a law \vas repealed which had formerly com-
pelled the physicians of the university to remain
unmarried), all of which are too innumerable 10
recount, did not benefit the barbers, who were
often used as a cat's-paw in the game, and had
the effect of causing surgery to be looked down
upon for several centuries. The surgeons were
excluded from the university, and, though their
science was based on anatomy, they were taught
and licensed by physicians, for whose instruction
anatomy was not considered necessary.

The contest was really one between the clerical
and the secular powers, more than one of simple
professional prejudice, — an example of the strug-
gle between dogma and the study of nature.

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Mediaeval Surgery and Treatment 479

In 1505 barbers in France were given the name
of surgeons, and from this time on their pro-
gress was continuous, and in 1655 surgeons
and barber-surgeons were incorporated in one
college. l

In other countries, as well as in France, the
evolution of the surgeon showed similar features.

The unlettered and crudely taught barber-
surgeon is still found in some countries of Europe
and in some of the foreign quarters of America.
He is called upon to do cupping (bleeding,
formerly one of his specialties, has died out, as
has also leeching) and to apply some special
treatment, such as counter-irritants,2 etc. In
England, in the olden times, his place was often
filled by the apothecary, who was supposed to be
able to do all sorts of specific things now entirely
transferred to the province of the nurse.

It is hardly possible to conceive of circum-
stances more painful and revolting than those
under which, in the absence of anaesthetics, the
surgery of the olden times had to be studied and
practised. A modern surgeon says:

1 Millingen, op. cit., p. 299.

2 The writers have kno\vn of some ghastly results arising
from the ignorance and self-confidence of these barbers;
thus in one case a physician had ordered a hot pack to be
given to a child of thirteen: and the family, recent emigrants
from Russia, called in one of their countrymen who followed
this calling. He gave the hot pack by using the fumes from
quick-lime in such a barbarous manner that the child, was
frightfully burned and succumbed to her injuries.

480 A History of Nursing

One shudders at the horrible cruelties which were
perpetrated on suffering mortals in the name of
surgery. Patients were held down upon the operating
table by brute force and were operated upon while in
full possession of their senses; they were heard to
shriek and to cry out in heartrending screams for a
discontinuation of their tortures; they were incised
with red-hot knives, and they were compelled to have
their wounds dipped in a caldron of seething tar to
control hemorrhage.1

Some of the most painful methods of surgical
treatment, such as searing wounds and ampu-
tations by boiling oil and red-hot instruments,
were discontinued by the famous Ambroise Par6
(1510-1590). He was not only one of the greatest
of surgeons, but one of the most humane of men,
and the account following, taken from his own
narrative, is a classic example of his surgery and
is also a striking model of good nursing. Par6
had been called to attend a young nobleman,
whose case had been given up as hopeless by the
medical attendants, and whose relatives had
persuaded the King to allow Pare to come to their
country estates in consultation. The great sur-
geon left this account of the case in his diary :

I found him in a high fever, his eyes deep sunken,
with a moribund and yellowish face, his tongue dry
and parched, and the whole body much wasted and

1 The History and Development of Surgery during the Past
Century, by Frederic S. Dennis, M.D., F.R.C.S. Reprint from
American Medicine, vol. ix., nos. 4, 5, 6, and 7, 1905.

Mediaeval Surgery and Treatment

lean, the voice low, as of a man near death; and I
found his thigh much inflamed, suppurating, and
ulcerated, discharging a greenish and very offensive
sanies. I probed it with a silver probe, wherewith
I found a large cavity in the middle of the thigh and
others round the knee, sanious and cuniculate; also
several scales of bone, some loose, others not. The
leg was greatly swelled and imbued with a pituitous
humor — and bent and drawn back. There was a
large bedsore; he could rest neither day nor night,
and had no appetite to eat, but very thirsty. I was
told he often fell into a faintness of the heart, and
sometimes as in epilepsy; and often he felt sick, with
such trembling he could not raise his hands to his
mouth. . . .

Having seen him, I went a walk in the garden and
prayed God He would show me this grace, that he
should recover: and that He would bless our hands
and medicaments, to fight such a complication of
disease.

I discussed in my mind the means I must take to
do this. They called me to dinner. I came into
the kitchen, and there I saw, taken out of the great
pot, half a sheep, a quarter of veal, three great pieces
of beef, two fowls, and a very big piece of bacon, with
abundance of good herbs; then I said to myself that
the broth of the pot would be full of juices and very
nourishing.

After dinner we began our consultation, all the
physicians and surgeons together. ... I began to say
to the surgeons that I was astonished they had not
made incisions in the patient's thigh, seeing that it
was all suppurating, and the thick matter in it very
foetid and offensive, showing that it had long been

VOL. I. — 31.

482 A History of Nursing

pent up there, and that I had found with the probe
caries of the bone and scales of bone, which were
already loose. They answered me, ' Never would
he consent to it"; indeed, it was near two months
since they had been able to get leave to put clean
sheets on his bed, and one scarcely dared to touch
the coverlet, so great was his pain. Then I said, "To
heal him, we must touch something else than the
coverlet of his bed. '

Each said what he thought of the malady of the
patient, and in conclusion all held it hopeless. I told
them there was still some hope, because he was
young, and God and Nature sometimes do things
which seem to physicians and surgeons impos-
sible. . .

To restore the warmth and nourishment of the body,
general frictions must be made with hot cloths above,
below, to right, to left, and around, to draw the
blood and the vital spirits from within outward. . . .
For the bedsore, he must be put in a fresh, soft bed,
with clean shirt and sheets. . . . Having discoursed
of the causes and complications of his malady, I said
we must cure them by their contraries, and must first
ease the pain, making openings in the thigh, to let
out the matter . . . Secondly, having regard to the
great swelling and coldness of the limb, we must
apply hot bricks around it, and sprinkle them with a
decoction of nerval herbs in wine and vinegar, and
wrap them in napkins; and to his feet, an earthenware
bottle filled with the decoction corked, and wrapped
in cloths. Then the thigh, and the whole of the
leg, must be fomented with a decoction made of sage,
rosemary, thyme, lavender, flowers of chamomile and
melilot, red roses boiled in white wine, with a drying-

Mediaeval Surgery and Treatment 483

powder made of oak-ashes and a little vinegar and
half a handful of salt. . . .

Thirdly, we must apply to the bedsore a large
plaster made of the desiccative red ointment and of
Unguentum Comitissae, equal parts, mixed together,
to ease his pain and dry the ulcer; and he must have
a little pillow of down, to keep all pressure off it, ...
and for the strengthening of his heart we must apply
over it a refrigerant of oil of water-lilies, ointment of
roses, and a little saffron, dissolved in rose- vinegar and
treacle, spread on a piece of red cloth.

For the syncope, from the exhaustion of the natural
forces, troubling the brain, he must have good nourish-
ment full of juices, as raw eggs, plums, stewed in wine
and sugar, broth of the meat of the great pot, whereof
I have already spoken; the white meat of fowls,
partridges' wings minced small, and other roast
meats easy to digest, as veal, kid, pigeons, partridges,
thrushes, and the like with sauce of orange, verjuice,
sorrel, sharp pomegranates; or he may have them
boiled, with good herbs, as lettuce, purslain, chicory,
bugloss, marigold, and the like. At night he can
take barley-water, with juice of sorrel and water-
lilies, of each two ounces, with four or five grains of
opium [this grain was ;<a barley-corn or grain'' in
weight] and the four cold seeds crushed, of each half
an ounce, which is a good remedy and will make him
sleep. His bread to be farmhouse bread, neither
too stale nor too fresh.

For the great pain in his head, his hair must be
cut, and his head rubbed with rose- vinegar just
warm, and a double cloth steeped in it and put there ;
also a forehead-cloth of oil of roses and water-lilies
and poppies, and a little opium and rose-vinegar,

484 A History of Nursing

with a little camphor, and changed from time to time.
Moreover, we must allow him to smell flowers of
henbane and water lilies, bruised with vinegar and
rose-water, with a little camphor all wrapped in a
handkerchief, to be held sometime to his nose. And
we must make artificial rain, pouring the water from
some high place into a cauldron, that he may hear
the sound of it, by which means sleep shall be pro-
voked on him.

As for the contraction of his leg, there is hope of
righting it when we have let out the pus and other
humours pent up in the thigh, and have rubbed the
whole knee with ointment of mallows, and a little
eau-de-vie, and wrapped it in black wool with the
grease left in it ; and if we put under the knee a feather
pillow doubled, little by little we shall straighten the
leg. . . .

The consultation ended, we went back to the
patient, and I made three openings in his thigh. . . .
Two or three hours later I got a bed made near his
old one, with fair white sheets on it; then a strong
man put him in it, and he was thankful to be taken
out of his foul stinking bed. Soon after he asked
to sleep; which he did for near four hours. . . .

The following day I made injections into the depth
and cavities of the ulcers, of /Egyptiacum dissolved
sometimes in eau-de-vie, other times in wine. I
applied compresses to the bottom of the sinuous
tracks, to cleanse and dry the soft spongy flesh, and
hollow leaden tents, that the sanies might always
have a way out; and above them a large plaster of
Diacalcitheos dissolved in wine.

And I bandaged him so skilfully that he had no
pain; and when the pain was gone the fever began at

Mediaeval Surgery and Treatment 485

once to abate. Then I gave him wine to drink mod-
erately tempered with water, knowing it would re-
store and quicken the vital forces. And all that
we agreed in consultation was done in due time and
order; and as soon as his pains and fever ceased, he
began steadily to amend .... In one month we got
him into a chair ... in six weeks he began to
stand a little on crutches, and to put on fat and get
a good natural colour. . . .*

A modern physician writes:

Some of our nurses, who to-day rarely use any-
thing more complicated than Thiersch, may be
interested in knowing what some of the remedies
used by Pare were. They may be found in the
Pharmacopeia Londinensis, by Nicholas Culpeper,
Gentleman Student in Physick and Astrology, 1695,
an interesting book, in which one can learn the
preparation of goats' blood, the burning of young
swallows, the preparation of earthworms, and other
interesting things. So, for example, "the skull of a
man that had never been buried, being beaten to
powder and given inwardly, the quantity of a dram
at a time in Betony water, helps palsies and falling
sickness." If you cannot get the skull of a man that
was never buried, "elk's claws or hoofs are a sovereign
remedy for the falling sickness, though it be but
worn in a ring, much more being taken inwardly" but
in the latter case ';<it must be the hoof of the right
foot behind. '

The desiccative red ointment that was used for the

1 Ambroisc Pare and His Times, Stephen Paget, G. P.
Putnam's Sons, New York, London, 18^7, ; p. 107-115.

486 A History of Nursing

bedsore of Fare's patient was made as follows: ' oil
of roses omphacine, a pound; white wax, six ounces;
which being melted and put in a leaden mortar, put
in earth of Lemnos or Bole-Armenick, lapis calami-
naris, of each four ounces, litharge of gold, ceruss, of
each three ounces: camphire, one drachm; make it
into an oyntment according to art."

Culpeper says : ' ' This binds and restrains fluxing of
humours and is as gallant an oyntment to skin a sore
as any in the dispensatory." Unguentum Comitissae
is made as follows: "Take of the middle bark of acorns,
chestnuts, oaks, beans, the berries of myrtles, horse-
tail, galls, grapestones, unripe services and medlars
dried, the leaves of sloe- tree, the roses of Bistort and
Tormentil, of each an ounce and a half; bruise them
grossly and boyl them in ten pounds of plantane-
water until the half be consumed; then take the new
yellow wax eight ounces and a half, oyl of myrtles
simple two pounds and a half; melt them and wash
them ten times in the aforesaid decoction; being
washed and melted put in these following powders ; the
middle bark of acorns, chestnuts, and oak-galls, juyce
of Hypocistis, ashes of the bone of an ox-leg, myrtle
berries, unripe grape-stones, unripe services, of each
half an ounce; troches of amber, two ounces, with
oyl of mastich so much as is sufficient, make it into
an oyntment according to art."

'This is also a gallant bynding oyntment, composed
neatly by a judicious brain,' says Culpeper; 'the
Egyptiacum to be dissolved in eau-de-vie is a simple
thing made of verdigreece finely powdered, five parts ;
honey, fourteen parts, sharp vinegar, seven parts.
Boil them to a just thickness, and a reddish color.
This potation cleanseth filthy ulcers and fistulaes

Mediaeval Surgery and Treatment 487

forcibly, and not without pain; takes away dead and
proud flesh, and dries. ' The diachalciteos is made
of " hog's grease, fresh and purged from the skins, two
pounds, oyl of olive omphacine, litharge of gold, beaten
and sifted, of each three pounds, white vitriol, burnt
and powdered, four ounces.

"Let the litharge, grease, and oyl boil together with a
gentle fire, with a little plantane- water, always
stirring it to the consistence of a plaster, into which,
(being removed from the fire) put in the vitriol, and
make it into a plaster, according to art. '

The stirring should be done with "the branch of a
palm or other tree of a binding nature, such as oak,
box or medlar, which is new cut, so that the virtue
of the spatula may be mixed with the plaster, cutting
off the top and the rind, even to the wood itself, the
mixture being thus made thick by boiling and stirring
and removed from the fire, put in white coperas for
want of true chalcitis in powder. " 2

The medical receipt books of all periods of the
Middle Ages were often compiled by women, who
were frequently more skilled than men in writing.
A quaint manual of this kind belonged to the
Dames de Charite, and is a medical glossary
containing descriptions of herbs and drugs, re-
ceipts for compounding medicines, tables of
symptoms for every common disease, with the
directions for appropriate treatment in every
emergency. The various stages of disease, with
the corresponding changes in treatment, are most

2 The Drugs used in the Time of Pare. By George Dock,
M.D. The American Journal of Nursing, May, 1902, p, 639.

488 A History of Nursing

quaintly and carefully described. Some of the
remedies are revolting in the extreme, and testify
to the indescribable vein of cruelty which ran
through our forefathers: thus, for a cataplasm,
'a living pigeon is to be cut down the back and
applied warm to the chest. '

On the other hand there are many excellent
and practical receipts for purgative and laxative
potions, enemata, and suppositories, while those
for meat broths, medicated wines, and all
manner of 'tisanes' or teas, show a great deal
of practical and useful knowledge. This col-
lection, which had been gleaned from the many
treasures of household and monastic medicine
carefully handed down from one generation to
another from the very earliest mediaeval times,
is a most interesting example of the queer mix-
ture of diagnosis, therapeutics, and nursing, based
on an equally grotesque combination of super-
stition and exorcism, derived from nature- worship,
with much that was practical, sensible, and
effective, that passed for medical knowledge and
formed the undisputed specialty of the good,
kind-hearted, energetic Lady Bountiful in the
days when medical science in Western Europe
was at a low ebb.1 These old medical books, or
Herballs, are now the costly treasures of anti-
quaries, who gladly pay sums that would have
amazed the original compilers. The Book-Lover's

1 Another example of this kind is Les Remedes Charitables de
Madam Fouquet. Lyons, 1685.

Mediaeval Surgery and Treatment 489

Leaflet, No. 142, announces the following ones,
among others :

A Boke of the Propreties of Herbes called an
Herball, whereunto is added the time ye herbes,
floures, and sedes should be gathered to be kept the
whole yere, with the vertue of ye herbes when they
are stilled; also a general rule of al maner of Herbes
drawen out of an Auncient boke of Physyck. (Lon-
don, about 1535.)

Another :

This is The Myrrour or Glasse of Helth necessary
and nedefull for euery person to loke in, that wil
kepe their bodye from the syckenesse of the Pesti-
lence, and it sheweth how the pianettes do raygne in
euery houre of the daye and nyghte, with the natures
and expositions of the XII sygnes, deuyed by the
XII Monethes of the veare, and shewed the remedies

for many dyuers infirmities and dyseases that hurteth
the bodye of Manne. (About 1535, London.)

Another :

The Garden of Health, conteyning the sundry rare
and hidden vertues and properties of all kindes of
Simples and Plants, together with the maner how
they are to be used and applyed in medecine for
the health of man's hody, against divers diseases
and infirmities most common among men. Gathered
by the long experience and Industrie of William
Langham, Practitioner in Physicke. (London, 1633.)

A very kindly, amiable, and practical English
teacher of home medicine and nursing has left
a valuable little book of this nature with the
following title-page:

49° A History of Nursing

The Good Samaritan; or Complete English Physician:
containing observations on the most frequent dis-
eases of men and women, infants and children, with
directions for the management of the sick, and a
collection of the most approved receipts for making
and preparing cheap, easy, safe, and efficacious
medicines, for their recovery. Likewise directions
concerning bleeding, delivered in so plain and easy
a manner, that any person of tolerable sagacity
may be his own physician, or direct for others with
propriety and success. By Dr. Lobb, member of the
Royal College of Physicians in London, and other
eminent practitioners. To which is added, a method
of restoring to life persons thought drowned, or in
any other manner suffocated. With infallible reme-

•/

dies for the bite of a mad dog, or any other animal.
Likewise preservatives from infections, etc. (No
date.)

On bleeding, the author says in his preface:

Of all the remedies recurred to in relieving the
diseased part of mankind, there are none of such
general service and advantage as that of bleeding;
as there is no one, on the other hand, attended with
more pernicious consequences, when indirectly and
injudiciously ordered. A number of illnesses are
absolutely owing to too great a quantity of blood;
in which cases there is ever of course an indispensable
necessity for proportionably draining this fluid. In
all inflammatory distempers, it is next kin to sacrilege
to omit it.

For the care of children, the Good Samaritan
gives a number of receipts for medicinal mixtures,

Mediaeval Surgery and Treatment 49 l

marking them A., B., C., etc., and then dis-
courses on the diseases of childhood. About
small-pox he says:

When children have the small-pox, if the pustules
are few, and continue increasingly in bulk, and the
suppuration of them proceeds well, there is no occa-
sion for medicines; but a suitable diet, especially
milk and apples, milk porridge, etc., with giving the
child now and then a little Sack or mountain whey
may be sufficient. If the pustules are very numerous,
and the fever continues, besides the suitable diet,
some medicines should be given; and the mixture
marked B, or that marked D, may be fitly given;
but if the disease is of the confluent kind, and a
looseness happens, often very happy for young chil-
dren, then the mixture marked C, is more proper.
When children have the measles, they should be fed
with the same sort of diet as in the small-pox ; if the
fever continues high, the mixture marked A may be
given, and in regard to the cough, which often at-
tends this distemper, the directions before mentioned
about this symptom, should be observed.

Small-pox seems to have been expected as a
matter of course, and its nursing care was evi-
dently of the simplest. Chicken-pox is treated
to-day with more seriousness, in the training of a
nurse.

The Good Samaritan then discusses fevers, with
special reference to the nursing care.

I shall now consider the Putrid Fevers, the most
destructive of acute distempers, and in such a manner
as may be most beneficial in families, by directing

492 A History of Nursing

those who act as nurses how to manage persons when
under any Fevers of the putrid kind.

These nurses may know, that the sick have a
Putrid Fever when they find the patient's pulse not
strong, but the heat of the body much greater than in
health, and yet his thirst great, his tongue black, or
of a dark- brown colour, and dry; and especially if
attended with one or the other of the following
symptoms, viz. i. Purple spots. 2. Hemorrhages.
3. Profuse sweats. 4. Loosenesses. Every nurse knows
whether one or the other of these happens, and I
would assist them to know what is proper for them
to do for the relief of the sick under this or that
symptom.

I shall now shew what is proper to be done when
either of the very threatening symptoms mentioned
shall occur; particularly: i. When the nurse shall
discover any flat spots in the skin, of a purple or livid
colour, let her try by thrusting a sharp fine needle
slowly into the middle of some of them, till the patient
feels pain from the puncture of the needle. If the
patient feels no pain, she may conclude that the spots
are so many mortifications, and that death will soon
follow. These are called Tokens in the Plague:
They sometimes happen in the worst sort of the
smallpox, and in some other Fevers.

When the patient feels the puncture of the needle
as soon as it enters the skin, it shews that the spots
are only superficial, and that there is no mortification ;
and that, although it is a bad symptom, yet the sick
may recover.

The remedies I recommended are the following
powders and drops: Take Tartar vitriolated, Cream
of Tartar, Salt Prunella, of each one scruple; mix

Mediaeval Surgery and Treatment 493

and make a powder to be divided into four equal
parts for so many doses; and let one of them be
given to the patient every two or three hours, mixed
with the balsamic syrup, and drinking after it four
of five spoonfuls of tea made with the Roots of
Tormentill, and sweetened with loaf sugar.

Take of the dulcified spirits of vitriol one drachm,
nutmeg water seven drams, and make a mixture.
Of this mixture so many drops may be given in a
coffee dish full of decoction of the shavings of Harts-
horn, sweetened with sugar, as will make it a little
sour, now and then a draught against thirst.

Let the spots be gently rubbed with a hair pencil
wetted with the following; foment once in four or five
hours :

Take Campian Powder one scruple, of the Tincture
of Myrrh one ounce, mix for a foment; or the spots
may be wetted with the rectified spirits of wine alone.

Recipes for the other symptoms and conditions
mentioned then follow in due order, and the nurse
is further told :

When the patient sweats abundantly, when the
pulse is not strong, and when the strength sensibly
decreases, and especially when they are cold and
clammy, the patient is in extreme danger.

Next comes:

A Method to recover such persons as have been
drowned, or in any other manner suffocated, provided
that they are not totally dead; which they may not be
for many hours after the accident happened. In
the first case they suspend them with their head
downwards near a fire, till such time as the body

494 A History of Nursing

begins to warm and throw out water by the Aspera
Arteria. Then they foment the whole Breast and
seat of the Heart, with Spirits of Wine, with Elixer
Vitae, or Bread dipped in strong Wines; this must be
frequently repeated. By such means, if they are not
quite dead, motion is again restored to the Heart,
which receives, by degrees, the Blood that it after-
wards repels to the Arteries, till at length Life entirely
returns.

A compress for sore throat is thus described :

To one Noggin of the Juice of pounded Nettle-
Root well strained, add Rose Water and White Wine
Vinegar each one spoonful; put them into a tin
sauce- pan, over a good fire, for about a quarter of
an hour, then set it by to cool; and when you mean
to use it, make it pretty warm, and soak a strip of
flannel in it, then scrape a little Nutmeg over the
wet flannel, and apply it on the outside of the part
affected: this you are to repeat twice in twenty-four
hours, when it will most certainly complete the cure.
Roll a strip of dry flannel over the one applied to
the part.

Here is a method for dressing a fresh (a " green ")
wound :

Prevent as much as may be the wound from bleed-
ing, since the blood (if not much corrupted) is one
of the greatest balsams. Then speedily mix some
White-wine Vinegar and common Table Salt bruised
fine together, and be not sparing of the salt; with
this wash the wound very well, and continue so to
do for some time; should the incision be deep, make
dossils, which steep in the above liquor and put plenty

Mediaeval Treatment and Surgery 495

of salt on them, with which to fill up the wound to
the surface of the skin, and lay a compress over well
impregnated with the above, then bind it up, and
every five or six hours pour some of the same liquor
on the dressing to keep it moist and open it but once
in twenty-four hours. When the flesh is grown up
(which it will very soon do if vou be not too effeminate

% - •

and afraid of the smart, but keep it clean,) apply a
plaster of Diacolon, to skin it over.

Many sources have been consulted by the
Good Samaritan, for he quotes:

The Lady York's choice Recipe to preserve from
the Small-pox, Plague, etc.

Take Garlic three heads; Essence of Wormwood
one Dram, Let them infuse twelve hours in four
ounces of White Wine, and drink the liquor before
you go among the infected; and afterwards the lady
affirms, you may go with safety among them.

A quaint remedy is this, for the ' Dry Belly-
Ach, or Nervous Cholick ' ' :

Take dried mallow leaves an ounce; Chamomile
Flowers, and sweet fennel seeds, of each half an
ounce ; water, a pint ; boil it for use. Take half a pint of
this decoction, and add two spoonfuls of sweet oil,
and half an ounce of Epsom salt; mix it for a clyster
to be repeated frequently. The Warm Bath is of
the utmost service in this disorder, as is also Balsam
of Peru given inwardly from twenty to thirty drops
in a spoonful of powdered Loaf Sugar, three or four
times in a day.

Another quaint one is this, " ForaConsumption":

496 A History of Nursing

Riding on horseback, a milk diet, country air, and
bleeding frequently in small quantities, at each time
taking away not more than six ounces of blood, are
the most efficacious remedies in this distemper, snails,
boiled in milk have sometimes been of service, as is
also the Peruvian bark, when it does not occasion a
purging.

The Good Samaritan had on the whole good
and rational ideas of nursing, and his book closes
with some general "Rules for nursing Sick Persons,"
which incidentally point out the errors that often
were then prevalent.

It is a great mistake [he says] to suppose that all
distempers are cured by sweating; and that, to pro-
cure sweat, sick persons must take hot medicines
and keep themselves very hot; for sweating carries
off the thinner part of the blood, leaving the remain-
der more dry, thick, and inflamed, which must
evidently increase the disorder; for instead of forcing
out the watry part of the blood, we should rather
endeavour to increase it by drinking freely of Barley
Water, Balm- Tea, Lemonade, or any other diluting
Liquor made luke-warm. What has already been
said on the head of foul confined air shews the ab-
surdity of stifling the sick person with the heat of a
close apartment and a load of bed-cloaths; for these
two causes are sufficient alone to produce a fever, even
in an healthy person. By letting in a little fresh
air, now and then into a sick person's room, and
lessening the bed cloaths, you will almost al-
ways perceive the fever and oppression in some
measure abate.

Mediaeval Treatment and Surgery 497

His remarks on nourishment are quite as
rational, and he concludes thus:

To procure a compleat and perfect termination of
acute diseases, observe the following rules : Let persons
recovering, as well as those who are sick, take very
little food at a time, and take it often. Let their meal
consist of one kind of food only, and let them chew
their food well.

Lessen their quantity of drink ; the best in general is
wine and water, three parts water to one part wine;
for too great a quantity of liquids prevents the stom-
ach from recovering its tone. . . . Riding on horse-
back, as often as they are able, is absolutely necessary;
the properest time for this exercise is in the forenoon.
They should eat nothing, or at the most but very
little, in the evening — their sleep will be the less dis-
turbed for this caution. . . .

Labouring men must by no means return to work
too soon after their recovery, lest it prevent their
ever getting perfectly well, and entirely recovering
their lost strength.

Fever patients (and it is impossible to find out
what the different kinds of fever were) were
probably often nearly starved by carrying the
fluid nourishment doctrine to excess, for a fam-
ous physician of the latter part of the eighteenth
century desired that the only epitaph placed
upon his tombstone should be this : " He Fed
Fevers."

In the treatment of the eruptive fevers the
practitioners of those days seem to have been
groping along the same lines as the modern

VOL. I. — 32

498 A History of Nursing

investigators of the various light-rays. The appli-
cation of red light to small-pox eruption has
received some attention recently, and in the Mid-
dle Ages small -pox and scarlet fever were treated
by red curtains and hangings. The bed of the
patient was hung with red curtains and the sick
person was swathed in a red gown.

The many strange, grotesque, horrible, or
superstitious types of medical treatment in the
Middle Ages, which are to be found in the pages
of medical historians, are, after all, often explained
by ancient theories on astronomical, botanical,
or zoological subjects; but one alone among
all prejudices and superstitions remains resistant,
deep-rooted in the minds of the people, and inex-
plicable,--it is the dread of fresh air.

Costume of Physicians and Other Persons when
Visiting Cases of Contagious Disease

Les Edifices Hospitaliers, Toilet, 1892. Hamelin Freres,

Montpellier

CHAPTER XIV

THE DARK PERIOD OF NURSING

IT is commonly agreed that the darkest known
period in the history of nursing was that
from the latter part of the iyth up to the mid-
dle of the igth century. During this time the
condition of the nursing art, the wellbeing of
the patient, and the status of the nurse all sank
to an indescribable levePof degradation.

Jacobsohn says l that it is a remarkable fact
that attention to the wellbeing of the sick, im-
provements in hospitals and institutions gener-
ally and to details of nursing care, had a period of
complete and lasting stagnation lafter the middle
of the seventeenth century, or from the close
of the Thirty Years' War. Neither officials nor
physicians took any interest in the elevation of
nursing or in improving the conditions of hospitals.
During the first two thirds of the eighteenth
century, he proceeds to say, nothing was done to
bring either construction or nursing to a better

1 Beitrage zur Geschichte des Krankencomforts . Deutsche
Krankenpflege Zeitung, 1898, in 4 parts.

499

500 A History of Nursing

state. Solely among the religious orders did
nursing remain an interest and some remnants
of technique survive. The result was that in this
period the general level of nursing fell far below
that of earlier periods. , The hospitals of cities
were like prisons, with bare, undecorated walls
and little dark rooms, small windows where no
sun could enter, and dismal wards where fifty
or one hundred patients were crowded together,
deprived of all comforts and even of necessaries.
In the municipal and state institutions of this
period the beautiful gardens, roomy halls, and
springs of water of the old cloister hospital of
the Middle Ages were not heard of, still less the
comforts of their friendly interiors.1

Was it by chance, or was it the logical result
of a definite cause, that this state of things was
coincident with a subjection of women in general,
so little questioned, so entrenched that it might
almost be called absolute? The latter conclusion
is irresistible. All the history of this time shows
women reduced by the slow pressure of masculine
domination to their lowest terms of self-expres-
sion. In education infantile (save for the small
groups of privileged women in each country who
were of the distinctly literary class), in occupation
limited absolutely to the four walls of private life
and domestic service, in legal relations weaklings
and dependents, women during this long dreary

1 Jacobsohn, o-p. cit.

The Dark Period of Nursing 501

period were effectually forbidden the right of free
initiative and a share in the shaping of the social
order. In all of the hospital and nursing work of
the Christian era this was the period of the most
complete and general masculine supremacy,
no time before or since have women been quite
without voice in hospital management and nursing
organisation, but during this degraded period they
were all but silenced. The ultimate control of the
nursing staff, of their duties, discipline, and condi-
tions of living, was everywhere definitely taken
from the hands of women and lodged firmly in
those of men. Even where a woman still apparently
stood at the head of a nursing body, she was only
a figure-head, with no power to alter conditions,
no province that she could call her own. 1 The
state of degeneration to which men reduced the
art of nursing during this time of their unrestricted
rule,1, the general contempt to which they brought
the nurse, the misery which the patient thereby
suffered, bring a scathing indictment against the
ofttime reiterated assertion of man's superior
effectiveness, and teach in every branch of ad-
ministration a lesson that, for the sake of the
poor, the weak, and the suffering members of
society ought never to be forgotten— not in
resentment, but in foresight it should be remem-
bered: Neither sex, no one group, no one person,
can ever safely be given supreme and undivided
authority. Only when men and women work
together, as equals, dividing initiative, authority,

502 A History of Nursing

and responsibility, can there be any avoidance of
the serfdom that in one form or another has
always existed where arbitrary domination has
been present, and which acts as a depressant,
effectually preventing the best results in work.

\ In England, where the religious orders had been
suppressed, and no substitute organisation given,
it might almost be said that no nursing class at
all remained during this period. It was forgotten
that a refined woman could be a nurse, except
perhaps in her owrn family; and even in good
homes if an attendant was called in the sick-room
became a scene of repulsive squalor. The drunken
and untrustworthy Gamp was the only profes-
sional nurse. 'We always take them without
a character," said an English physician not very
many decades ago, " because no respectable woman
will take such work." Even the Sisters of the
religious orders, though retaining their sweet
charm of serenity and gentleness, came to a
complete standstill professionally as nurses, on
account of the persistent sequence of restrictions
which had been hemming them in from the middle
of the sixteenth century. The clergy continually
interfered in and hampered their work by imposing
on them all manner of absurd restrictions; they
forbade all sorts of necessary practical details
to them on the ground of impropriety ;\shut them
out from advancing physiological knowledge and
the progress of the age in natural science, and
obliged them to spend time in religious exercises

The Dark Period of Nursing 503

which should have been given to the patients
or to the care of their own health, thus reducing
their efficiency and bringing about the identical-
deterioration against which Vincent de Paul
had insistently warned the Sisters of Charity.
Although the nun gave medicine and certain
kinds of treatment. ' watched ' in private duty,
and supervised in hospitals (wrhere she maintained
discipline, system, and an atmosphere of refine-
ment), she did not really nurse the patient except
in a closely circumscribed way, and the actual
nursing in all of the large public institutions
of Europe passed into the hands of the 'merce-
naries," or lay attendants. These attendants or
servant-nurses, men and women, among whom
have indeed been found some excellent and faithful
characters, though the majority were of a sadly
inferior type, have probably had a labour history
as wretched as any in the long tale of wagedom.
Poorly housed, or rather roomed, in dark, un-
healthy dormitories or cupboards; ill-fed, over-
worked, and underpaid, ignorant, untaught, and
unorganised, they wrere kept in a state of abject
degradation from which there was no chance to
rise, so that it cannot seem strange that no more
intelligent personnel should offer itself for such
service. The hours of work alone, of which we
will presently give more details, tell the story :
from twelve to forty-eight hours of continuous
service, — twenty-four being quite ordinary, — with
a fewT irregular periods between for feeding (it

504 A History of Nursing.

cannot be called anything else), and sleeping,
meant of course that wearied nature must suc-
cumb and that the servant-nurses slept while the
patients nursed each other.

The age was a callous and brutal one; with
here and there the radiance of a true humani-
tarian to lighten the darkness. An article written
in England in 1789 by William Nolan describes
in a very earnest and dignified style the abuses
of hospitals which he had seen and felt compelled
to protest against.1 He relates instances of
the heartlessness of the nurses and Sisters, the
unfeeling indifference of great physicians, the reck-
lessness with which the surgeons order amputa-
tions, the levity and callousness of the young
students. He had seen the incoming patient
halted at the door of the ward by a loud-voiced
virago (the so-called Sister), who demanded her
fee before he could enter. One feature of the
management that Nolan scores with deserved
sarcasm and feeling was this : It was the custom
of the physicians to call the discharged patients
into an office when leaving, and inquire of them
whether the nurses and Sisters had been kind to
them. Naturally the departing patient, thankful,
no doubt, to escape with his life, made little com-
plaint, or, if he did, one can easily imagine how
ineffective it must have been when he himself was
no longer there to prove his statements. The

1 An Essay on Humanity: or A View of Abuses in Hospitals
with a Plan of Correcting TJtem. Wm. Xolan. Murray, 1789.

The Dark Period of Nursing 505

physicians, who themselves had little or no influ-
ence in the departments of hospital administration,
no doubt wished the patients to be well treated
and were probably unaware of the futility of such
precautions. Nolan urged the formation of a
Humane Committee to visit hospitals and exert
a restraining influence. But even he did not
dream of the restraint that was to be exerted in
a few decades by the presence of gentlewomen in
the wards.

While Nolan noticed only the coarseness and
callousness of the attendants in hospitals, a writer
signing himself ' One Who Has Walked a Good
Many Hospitals," in the London Times of April
15, 1857, defends the servant-nurses of the large
hospitals in London in the following words :

Hospital nurses have been much abused; — they
have their faults, but most of them are due to the
want of proper treatment. Lectured by Committees,
preached at by chaplains, scowled on by treasurers
and stewards, scolded by matrons, sworn at by sur-
geons, bullied by dressers, grumbled at and abused
by patients, insulted if old and ill-favoured, talked
flippantly to if middle-aged and good humoured,
tempted and seduced if young and well-looking —
they are what any woman might be under the same
circumstances.

The same writer gives an instance of two old
hospital Sisters, one who had remained twenty-
two and the other twenty -four years in charge of
wards, who were then discharged with small

506 A History of Nursing

gifts and afterwards allowed to do charing in the
same hospital to eke out a living. Any one ac-
quainted with the conditions of well-conducted
hospitals to-day will receive a clear impression
of the squalor of the time under consideration
from the regulations of the Royal (naval) Hos-
pital at Haslar in 1789, which John Howard,
among his other treasures of information has pre-
served in Lazarettos and Hospitals.1 It is well
worth studying for the picture it gives, and we
have extracted the most striking parts, as
follows :

III. That no dirt, bones, or rags, be thrown out of
any window, or down the bogs, but carried to the
places appointed for that purpose; nor are any
clothes of the patients, or others, to be hung out of
any of the windows of the house.

IV. That no foul linen, whether sheets or shirts,
be kept in the cabins, or wards, but sent immediately
to the matron, in order to its being carried to the
wash-house; and the nurses are to obey the orders of
the matron in punctually shifting the bed and body
linen of the patients, viz. : their sheets once a fort-
night, their shirts once in four days, their nightcaps,
drawers, and stockings once a week, or oftener if found
necessary.

V. That no nurse or other person do wash in the
water closets. . . .

VIII. That no nurse do admit any patients, on
any pretense whatsoever, into her cabin, nor suffer

' Pp. 181-182. Edition of 1789.

The Dark Period of Nursing 5°7

any person to remain in it at night, not even her
husband or child.

IX. That any person concealing the escape of any
patient from her ward, or that has not made due
report, at the agent's office, of her having missed such
patient, be discharged the hospital, upon proof

thereof.

X. That all nurses who disobey the matron's orders,
get drunk, neglect their patients, quarrel or fight with
any other nurses, or quarrel with the men, or do not
prudently or cautiously reveal, to the superior officers
of the house, all irregularities committed by the pa-
tients in their wards (such as drinking, smoking
tobacco in the wards, quarrelling, destroying the
medicines, or stores, feigning complaints and ne-
glecting their cure) be immediately discharged the
service of the house, and a note made against their
names, on the books of the hospital, that they may
never more be employed. .

The orders for the patients are equally remark-
able:

I. No one shall be guilty of blasphemous ex
pressions, unlawful swearing, cursing, drunkenness,
uncleanness, lying, or other scandalous actions, to
the corruption of good manners, and in derogation of

God's honour.

II. All shall behave with proper respect to the
officers of the hospital; and none shall presume to
quarrel or fight in the hospital.

III. No one shall absent himself from the hospital

without leave.

IV. No one shall pilfer, pawn, or damage any of

508 A History of Nursing

the furniture or things appertaining to the hospital,
or to any persons therein; nor shall any one defile, de-
face, or damage any part of the hospital.

V. Xo person shall walk on the grass-plats, in the
area of the building, nor ease themselves in any
place not allotted for that purpose. . . .

Still more direct light is shed upon the status of
nursing in English hospitals of that time by a
curious correspondence which, fortunately, has
been preserved for our edification. Somewhere in
the early decades of the nineteenth century, a cir-
cular letter was addressed (by whom is not re-
corded) " to medical chiefs of hospitals, chaplains,
governors, and officials of hospitals," and this letter
with its replies is unique from more than one
point of view. It recites the neglected spiritual
state of patients in free hospitals, and inquires
into methods of remedy for this condition. The
clergy are evidently too busy to visit the poor in
hospitals; 'the medical men (wisely it may be)
'object to the system of indiscriminate visiting
by ladies who, from ignorance of the cases, may
over-excite the body in their attempts to arouse
the soul." The time of illness is regarded as a
time peculiarly appropriate for teaching religion,
and it is suggested that the nurses in the hospital
might receive instructions from the chaplain
which would enable them to read prayers, conduct
courses of Bible reading with the patients, and
otherwise religiously instruct them. To quote
the exact words of this singular appeal:

The Dark Period of Nursing 509

He [the chaplain] directs her [the nurse] what
prayers she is to use, inquires what course of Bible
reading she means to adopt, and, if he finds her in-
capable of selecting one herself, sketches one for her,
and instructs her how to carry it out. She also learns
from him how she is to deal with every variety of
spiritual condition in those under her charge.

The matron is responsible for the carrying out of
these instructions — once a week she gives an account
to the chaplain of the religious state of the patients-
one evening in the week the chaplain meets the as-
sembled nurses; each head nurse successively gives
him an account of what she has read in her ward,
having entered it daily in a book kept for the purpose.
All the nurses who can be spared are present during
these lectures. The chaplain concludes by ques-
tioning them as to what they would say, what text of
Scripture they would quote, if the patient be self-
righteous or despairing, impatient or trifling, putting
imaginary cases to them, and correcting their answers.
Chaplains are earnestly requested to consider this
important subject.

It seems extraordinary that the clergy, for
whatever reason, should have paid so little at-
tention to hospital patients that such a letter
should have been thought necessary; almost
as extraordinary, and highly characteristic of a
certain sickly and canting sentimentality which
was widespread at that period, that the need of
religious instruction for patients, who were then
in every human relation neglected, should have
been so seriously taken to heart while their urgent

5io A History of Nursing

physical needs were quite overlooked. If the
good author had had any sense of humour (which
is not likely) he (or she) must have felt the touch
of absurdity as the answers came in.

' If I can but obtain a sober set of nurses,
wrote one, 'it is as much as I can hope for."
All of the replies were discouraging :-

I inquired from Dr. - about the characters of

the nurses, and he says they always engage them
without any character, as no respectable person would
undertake so disagreeable an office. He says the
duties they have to perform are most unpleasant,
and that it is little wonder that many of them drink.
... I know that a respectable woman was declined
the other day, as being too good for the situation.
The only conditions that are made are . . . that they
are not confirmed drunkards. The nurses . . . are
engaged by the house-surgeon, who is the master
and head of the situation. The only testimonials
required are an ordinary character for sobriety,
cleanliness, morality, and general respectability. If
they have filled a similar position before, so much
the better, but this is not a sine qud tton. Their
wages are from 6 to 8 shillings a week. In general
they are not educated at all. . . .

Inasmuch as we can only afford to have one (nurse)
she must be a hard-working slave, and her time is too
much occupied both day and night to do more than
actually devolves upon her as a mere nurse. . . .

The style of nurse should be very different from
what we have now; if not of a higher social grade at

The Dark Period of Nursing 511

least better instructed and suitably trained. But
nurses of this latter class would demand higher wages
than probably we could afford. . . .

I do not know how many of our nurses would be
competent to join in such a plan at the one proposed.
One of them I know has only been learning to read
within the last few years (!)...

What is wanted is a small staff of nurses or matrons
in each hospital of a higher rank, who would tone and
leaven the whole body of nurses. As it is, there is
nobody [wrote one cynic] who seems to think of the
nurses' souls. . . .

It is very difficult to provide efficient and re-
spectable nurses, particularly for the men's wards.
All that is required of candidates for the situation
is that they are respectable in character and have had
some experience in nursing. Generally speaking
they are char-women or persons of that grade. . . .

If the nurses in hospitals were anything like what
they are in many hospitals abroad, anything ap-
proaching even to what they are at Kaiserswerth, the
matter would be very simple. But I fear it is la-
mentably otherwise. . . .

The average number of nurses is one to every ten
patients by day and one to twenty at night. You
may imagine their time to be fully occupied. . . .

The chief difficulty I see in the plan is the present
character of hospital nurses. . . .

The funds of the hospital do not allow of the em-
ployment of more nurses than are barely enough for

512 A History of Nursing

the physical care of the patients, and it would be
perfectly impossible to collect any number of them
at any one time for a lecture. . . .*

The story was the same in every country. Even
in Holland, where Howard had found the most
enlightened methods in institutions, and in Den-
mark, where Halda had once anticipated the
work of Henri Dunant, educated gentlewomen
disappeared from hospitals except where pro-
tected by a religious order. Mrs. Norrie writes :

In 1625 women nurses were only engaged in the
proportion of one for every ten patients, and these
seem to have been of the Gamp order. But at this
time the work entrusted to women in the tenth and
eleventh centuries was taken out of their hands, as
the regulation Danish field hospitals in Holstein in
1758 further show, these being modelled after the
French regulations. According to these regulations
medical students did the nursing, with the help of
orderlies, and women were only hired to scrub; for
the regulations state that the housekeeper shall
engage as many strong and healthy married women
as the head-physician deems necessary to keep the
lodgings of the patients clean and to do the laundry
work. Further details of the women's work are as
follows: " Every morning one hour before the doctor's
visit the women shall take out all close-stools, bed
utensils, and spittoons, and cleanse them well.' ' It
a very weak patient or a man severely wounded should

1 Hospitals and Sisterhoods. London, Murray, 1855. No
author given on title page, but known to have been written
by Mary Stanley, sister of Dean Stanley. Pp. 10-28.

The Dark Period of Nursing 5J3

catch vermin, the women shall often comb his hair
and make him clean. ' The regulations prove further
that the medical students did the nursing. They
had to administer the medicine in the presence of
the head-physician that he might better control the
effect of it, and that it might be prevented that the
medicine be spent for other purposes than for
the benefit of the patients. 'If a man be severely
wounded the surgeon shall pay a visit once during
the night to alleviate his pain and to supervise that
the surgical student on duty is present, and that the
orderly is also present and takes care of what he has
to do. ' The surgeons prepared all the dressings
and dressed the wounds. They changed the poul-
tices, used the catheter, gave enemata and watched
at night.1

In some Continental countries the dark period,
resisting all outer influences, has survived into
our own day, as is well shown by a study of the
great hospitals of Rome and Vienna. As we
shall not soon again recur to these countries
we will give in this connection, where by kinship
it properly belongs, a summary of the conditions
still existing for the nursing staffs in their hospitals.
In 1901 an investigation of all the Italian hos-
pitals was made by Signora Angelo Celli as to the
hours of work and general conditions of living
of the servant-nurses, both men and women,
who during the past couple of centuries appear
to have been utilised to a greater extent than

1 "Nursing in Denmark," Charlotte Norrie, American Journal
of Nursing, Dec. 1900, p. 183.

VOL. I. 33,

514 A History of Nursing

ever before, perhaps owing to the increasing size
of hospitals, the diminishing number of lay Sis-
ters, oblates, and tertiaries, or to changed eco-
nomic conditions. \Yhile the nuns in charge of
the wards are under the control of a Motherhouse,
these servants, who are the actual nurses, are subor-
dinates to the lay administration of the hospitals.
Of forty-five hospitals six gave these servant-
nurses twelve consecutive hours of work. A
number gave from ten to fourteen. A favourite
plan was found to be a varying scale, as: on the
first day, nineteen consecutive hours ; second day,
eleven hours; third day; eleven hours. The round
was then repeated. Another example of this
kind reported was: first day, seventeen consecu-
tive hours; second day, seventeen hours; third
day, eight hours ; fourth day, five hours. Another :
first day, thirteen hours ; second day, eleven hours ;
third day, ten hours; fourth day, seventeen hours.
After this the nurse had one day free. One hos-
pital actually required thirty-seven consecutive
hours of work for every third working day; two
others ranged between twenty-four and forty-
eight consecutive hours, and one required thirty
hours alternating with forty-eight hours of service,
before a prolonged period of rest was given.

Of sleeping accommodations, some hospitals

furnished none, and others provided dormitories

'low and small," holding as many as forty in a

room. Not all furnished the food for their nurses

and some provided a part only of the food necessary

The Dark Period of Nursing 515

for an adult worker. What was given was usually
served by weight. If it be asked, ' Where could
people be found willing to take such positions?'
the melancholy truth comes to light that the
foundling asylums supplied most of the wretched
human material for this wage slavery, and that
these unfortunates were brought up to know
nothing else.1

In Austria the same inhuman conditions existed
and still exist to-day. In no country is a more
crushed and downtrodden nursing personnel to
be found. The celebrated General Hospital of
Vienna, long famous as a medical school, gave
and gives yet a twenty-four hour duty, alternated
by a da}^ broken' with certain duties from eight
to ten, from twelve to one, and from four to five,
then the night to sleep, and then again the
twenty-four-hour period.

The nurses in both male and female wards, one
to every ward of forty patients, are almost entirely
women. They are recruited from the ranks of un-
educated, needy, timid, and submissive labouring
women, and it would be a cruel injustice to regard
them as anything but victims of a bad system.
There is no matron or woman directress over
them. They are engaged, ruled, paid, and dis-
charged by the director of the hospital. Their
sleeping accomodations are cubicles in the wards-
not outside of the wards, but in them — on a line

1 " La Donna Infermiera," by Anna Celli, in the Unioiw
Femminile, Nos. 3, 4, 7, 8. Milan, 1901.

516 A History of Nursing

with the patients' beds. In these boxes they
also take their meals, which they bring up for
themselves ; their wages are about equal to sixteen
dollars a month, and they must naturally, like
the Italian and French nurses, look for gratuities
from the patients' friends.

In this hospital there is no woman superin-
tendent to vex by her assumption of authority
over the nurses, or by her insistence on instruction,
regular hours, or consideration for them. There
is no Woman's Board to interfere with the direc-
tors and make suggestions to the medical staff.
There is no religious Motherhouse to take the
blame for what goes wrong. There is only a
single, unmodified, and unlimited male control,
and this must be regarded as representing the
system and standard of nursing which the male au-
thorities consider satisfactory and desirable. It was
of this system (not by any means limited to this one
hospital) that Florence Nightingale wrote, in 1863 :

The nurses, whether male or female, are under the
sole command of the male hospital authorities ; in this
case the arrangements as to hours, proprieties, and
sanitary rules generally, would strike anyone as all
but crazy. Such are the rules which give nurses
twenty-four hours 'on duty' in a ward, or which
put them to sleep with the sick, of which the extreme
case is where a female nurse is made to sleep in a
men's ward, etc. In [this] case the nurses are de-
stroyed bodily and morally.1

1 See vol. ii.. Miss Nightingale's Writings.

The Dark Period of Nursing 517

The most powerful factor for the improvement of
public institutions which the eighteenth century
can show was undoubtedly the series of investiga-
tions into their condition made by John Howard.1
In the whole history of patient philanthropic en-
deavour no one pursued the good of his fellow-men
along a more awful road than he. His investiga-
tions into prisons, dungeons, asylums, pest-
houses, and hospitals are unparalleled in the
annals of humane effort, and only Dorothea Dix's
efforts in behalf of the insane in the United States
more than a century later are to be compared
to his. The prisons and lazarettos were his chief
concern. He visited hospitals incidentally, as
it were, but has left such graphic notes of
what he saw that we shall presently quote
them as the comments of an eyewitness on our
subject.

Bad though many hospitals were, they formed
the sunny side of Howard's work. The condition
of prisons was so inconceivably hideous that mind
and eyes alike quail before the cold print of the
pages on which he has so concisely and with
matter-of-course moderation set down his facts.
It was at the time when the death penalty was
affixed to the most trifling crimes against property
-when a handkerchief, a few turnips, or some
silver picked from a pocket, were more sacred than
the life of a human being. Yet death, except for

1 See Life of John Howard, by James Baldwin Brown,
London, 1823.

5*8 A History of Nursing

the helpless family left behind, was kinder than
the fate of the prisoner.

John Howard was born in rj2j^_and began his
investigations of prisons when he wTas about forty-
three years old. Upon a voyage to Lisbon his
vessel had been captured off the coast of France
by a privateer, France being at war with Spain.
Passengers and men were all thrown into a French
prison. So horrible was it, and what he learned
from his fellow-sufferers of prison life made so deep
an impression on him, that he determined to de-
vote his life to the amelioration of such conditions.

Possessing, fortunately, wealth and leisure, this
extraordinary man began a series of visitations
of prisons in his own country and on the Conti-
nent, making, up to the time of his death, in all,
seven Continental tours, in the course of which
he travelled 60,000 miles at an expense of £30,000.
In these travels he inspected all the gaols of Eu-
rope and descended into dungeons and under-
ground graves for the living that no other human
being outside of the victims and the gaolers had
ever seen. Few persons would have been able to
endure, not only the sights of misery, but the
indescribable filth, the foul air, and the horrible
stench, that was so overpowering that he had to
travel on horseback because he could not endure
the smell of his own clothes in a carriage. It was
his custom to rise at 2 A.M. to write his notes. Six
hours' sleep was his maximum indulgence. He took
a daily plunge in cold water and was a vegetarian

The Dark Period of Nursing 519

in his diet. In the course of his labours he had
opportunities for making his reports to many
crowned heads and rulers, and in every country
some mitigation of horrors followed his visits
and reports. He said of himself," I am the plodder
who goes about to collect material for other men
to use."

It became his hope to collect such information
and statistics in regard to the plague as would be
of service in attempting to mitigate it, and with
this aim in view his investigations were turned to
the lazarettos or quarantine hospitals, which he
inspected assiduously in every seaport of Europe.

HIS COMMENTS ON HOSPITALS.

In Italy he speaks of the devotion of the friars
and nuns to the sick; mentions a large hospital
in Rome as crowded and with bad air, but with
only one patient in a bed. He notes that in Italy the
physicians were convinced of the infectious nature
of phthisis, that there were separate wards for
this malady, and that the same precautions were
taken to prevent infection as in the case of the
plague. In private houses rooms were scraped
and fumigated and furniture destroyed after the
occurrence of phthisis.1

The hospital of the Ben Fratelli in Naples was
clean and elegant, with lofty wards, like chapels.

The large hospital in Genoa was one of the

1 Prisons arid Hospitals, p. 1 16, edition of 1784.

520 A History of Nursing

best and least offensive (in smell) of all the public
hospitals in Italy, but the rooms for the insane
were close and dirty, with mild and violent pa-
tients together. i

In Munich, the hospitals of the Brothers and
Sisters of Mercy were "neat and clean, still and

quiet." He noted the operation of bleeding
performed by the nuns ' with great dexterity and
tenderness." 2

In the hospital of St. John at Brussels the wards
were close, and the air at night was :< offensive
beyond all description.'' Here was also a ' hos-
pitable mansion' where the nuns cared for the
insane with a 'tenderness that gave me no little
pleasure."

' The great attention of the nuns distinguish
the hospitals in Roman Catholic countries.'
(Howard was a strict C;.lvinist, but had a firm
regard for the nuns, which they seem to have re-
ciprocated.) He speaks of their "pale looks."

In Madrid he notes, The contagiousness of
consumption is supposed to infect not only the
clothing, bedding, and furniture, but also the
walls and the ceiling." He found the Madrid
hospital quite good, although the prisons were
horrible.4

In Spain there were no nuns in men's wards,

1 Prisons and Hospitals, p. 129, edition of 1784.

2 Ibid., p. 130.
^ Ibid., p. 145.
4 Ibid., p. 158.

The Dark Period of Nursing 521

and the latter were close and offensive; the pa-
tients took snuff and spat; there was a preju-
dice against fresh air, also against washing the
rooms. The custom of washing the hands and
feet of the patients before putting them to bed
was not observed here. ' I am persuaded, how-
ever," he wrote, " that such a custom, with air,
cleanliness, and an abstemious diet, are of more
necessary importance in hospitals than any ad-
ministration of physic." 1

Lille had two quite model hospitals, La Com-
tesse and St. Sauveur. The patients were classi-
fied and each class had its own ward, while every
patient had a separate bed.

When a sick person arrives in either of these hos-
pitals he is immediately shown his bed, after which
one of the Sisters brings warm water to him, washes
his feet, dries them, and kisses one foot. Another
brings clean sheets and towels. A man servant makes
and warms the bed and the patient gets into it. All
the patients are kindly attended by the nuns, but,
from prejudices caused by their retired mode of
living, some inconveniences arise, such as neglect
of washing the rooms and opening the windows, in
consequence of which the wards are rendered offensive
and very unhealthy, especially at night. 2

The great hospital of the Salpetriere in Paris had
5000 poor and insane women and girls, with three
infirmaries.

1 Prisons and Hospitals, p. 163, edition of 1784.

2 Ibid., p. 165.

522 A History of Nursing

The hospitals of St. Louis and Hotel-Dieu are the
two worst that I have ever visited. They were so
crowded that I have often seen five or six patients
in one bed, and some of them dying.

The hospital of St. Louis stands out of the city. . . .
The wards are dirty and noisy and in many of the
beds are three patients.1

La Charite is one of the best in Paris. All of the
beds are single: it " does honour to the order of St.
Jean de Dieu."

At the Hopital des Petites Maisons a number of
small houses around the court sheltered aged and
infirm of both sexes with single rooms for the
insane. " The good Sisters kindly attend. . . .
The neatness and cleanliness here engaged me
often to repeat my visits."

" I advised washing the men's wards, but my
advice has not been taken. ';

The best hospital he saw in France was the
Hotel-Dieu at Lyons. The wards were thirty-
two feet wide and twenty-five feet high, with two
tiers of windows. Each ward had three rows of
iron beds. The different diseases were classified
and treated in separate wards, all airy and pleas-
ant, and as the patients convalesced the)' were
removed to special large and pleasant quarters.
The Sisters of a religious order, dressed in neat
uniforms, made up as well as administered all the
medicines. The apothecaries' shop is 'the neat-

1 Prisons and Hospitals, pp. 176, 177, edition of 1784.

2 Ibid., pp. 177, 178.

The Dark Period of Nursing 523

est and most elegantly fitted up that can be
conceived.''

Of the Royal Infirmary in Edinburgh he says:

Few hospitals in England exceed it in airiness and
cleanliness. The walls are whitewashed regularly.

Again in Italy he speaks of the 'filthy habit of
spitting on the floors ; patients with coughs should
be supplied with such little boxes or basins as are
used in Holland."

In Constantinople the Turks had few hospitals,
only a :'sort of caravansery, with sick and dying
objects lying on dirty mats on the floor.' The
hospitals for lunatics were well built, but no
attention was paid to cleanliness or to the pa-
tients. The Jewish hospital was the best in
Constantinople.2

In Ireland, in the Maryborough Infirmary,

in a room called the tower, with two patients, there
was a little dirty hay on the floor where they said the
nurse lay ... no sheets in the house and the blankets
very dirty; — no vault, no water. The surgery was
a closet about ten feet six inches, its outfit consisting
of ten vials, some of them without corks, a little
salve stuck on a board, and some tow.3

In another county infirmary the nurses' lodging
is under the staircase.4

^Prisons and Hospitals, p. 180, edition of 1784.
2 Lazarettos and Hospitals, p. 64.
* Ibid., p. 86.
« Ibid., p. 93.

5^4 A History of Nursing

I am persuaded [he writes] that much depends on
the patients lying on fresh and clean beds ; . . .if the
annual sum spent in several hospitals for the destruc-
tion of bugs was expended in airing, beating, and
brushing the beds, the end would be much better
answered.

He had seen this done in Sweden.

CHAPTER XV

THE PRE-FLIEDNER MOVEMENTS OF PHILAN-
THROPY AND NURSING

AS is well known, the reform in nursing of the
past century began with the foundation of
the Deaconess Motherhouse of Kaiserswerth on
the Rhine, where Friederike and Theodore Flied-
ner wrought the revival, so richly fruitful in
results, of the ancient order of deaconesses in a
modern setting. But before the Fliedners began
their work there had been a long series of efforts
and strivings which had prepared their way.
So inevitably does it happen in the course of
human achievement that many attempt and fail,
or succeed only in part, as a prelude to the final
success of one gifted person or group of individ-
uals. Others immediately preceding them had
conceived the idea which the Fliedners worked
out, but they did not see its fruition. Indeed the
source of the current must be sought even farther
back. The ancient churchly order of deaconesses
had never quite died out. We have seen that it
lingered in the Eastern Church up to the twelfth

525

526 A History of Nursing

century, and in the churches of Gaul and Ireland
long after it had disappeared from Rome. The
Waldenses, whose history dates from 1170, had
revived to some extent, if not the exact form,
at least the spirit and the works of the early
deaconess, and had selected women who devoted
themselves to works of charity and nursing.
The followers of John Huss, who was born in 1369,
had also a similar form of service. Schafer cites
a number of communities in which women's work
was similarly organised after the Reformation.1
In Minden, in 1530, the church decreed that an
order of district nurses and visitors for the poor
should be established. The name deaconess,
however, was not given them. Keppel had a
charitable institution from about 1567 to 1594
where the works of the deaconess, including nurs-
ing, were carried on; also at Walsdorf there was
a similar community, with an abbess at the head.
The members of the sisterhood were admitted
after their eighteenth year for a year's probation,
if of exemplary character. Entrance was entirely
voluntary, without coercion from elders or re-
lations, and the Sisters were free to leave or marry
at any time. After acceptance, they were con-
secrated with a religious ceremony. They had
different duties, teaching, visiting, etc., but one
among them had charge of the sick and the poor,

1 Die Geschichte der Weiblichen Diakonie, Theodor Schafer,
and edition, Stuttgart, 1887. See chap. iv.

The Pre-Fliedner Movements 527

both in the asylum and out of it, and she was
called the " deaconess."

The town of Wesel, in Germany, had deaconesses
from 1575 to 1610, who were- chosen, after the
fashion of the early Church, by the congregation.
The Reformed church in Wesel was composed of
refugees from Holland and elsewhere, and one of
the first acts of the congregation was to decide
that women, styled "deaconesses," were to be
officially employed by the presbytery for service
among the poor and to nurse the sick. The re-
vival was short-lived, it is true. The General
Synod in 1581, when appealed to to confirm the
action of the congregation, decided against it

on account of various inconveniences which might
arise from it; but in time of pestilence and other
sickness, when any service is required among sick
women which would be indelicate for deacons, they
ought to attend to this through their wives, or others
whose services it may be proper to engage.1

It is quite possible that the negative of the synod
alone might not have discouraged the order, for
we have seen that similar and even more em-
phatic edicts had at various times been ignored ;
but other causes, among which was the intro-
duction of a system of state relief, also operated
to extinguish it.2

In the Netherlands deaconesses were instituted

1 Schafer, op. cit., vol. i. p. 75.

2 Deaconesses, Ancient and Modern, by Rev. Henry Wheeler,
New York, Hunt & Eaton, 1889, pp. 168-169.

528 A History of Nursing

at an early date. The city of Amsterdam had
them from 1566, when "certain elderly and godly
Sisters were chosen as deaconesses," and the
title deaconess still attaches to certain workers in
charitable institutions there.1 For visiting nurs-
ing by the deaconesses the city was divided into
four sections. The work was arduous and the
deaconesses did not serve for life, but for given
periods. Every year some wrere released, and
received the thanks of the church fathers, while
others were consecrated. They continued to
live in their own homes; even those WTho were in
charge of institutions did not necessarily reside in
them. A notable deaconess was the sister of
pastor Calkoen, whose many sermons on the
apostolic deaconess are still extant. The chroni-
cles of the Pilgrim Fathers give a quaint picture
of an old Amsterdam deaconess:

At Amsterdam they were . . . three able and godly
men for deacons, one ancient widow for a deaconess
who did them much service for many years, though
she was sixty years of age when chosen. She hon-
oured her place, and was an ornament to the congre-
gation. She usually sat in a convenient place in the
congregation with a little birchen rod in her hand,
and kept little children in great awe from disturbing
the congregation. She did frequently visit the sick
and the weak, especially women, and as there was
need called out maids and other young women to
watch and do them other helps as their necessity

» Schafer, vol. i., p. 77.

The Pre-Fliedner Movements 529

did require; and if they were poor she would gather
relief for them of those who were able, or acquaint the
deacons, and she was obeyed as a Mother in Israel
and an officer of Christ.1

Later, in 1745, the founder of the Moravians,
Count Zinzendorf , consecrated a group of deacon-
esses by the imposition of hands. Their position
and functions corresponded closely to the dea-
conesses of apostolic times. The Moravians still
have chosen women, practically the same as the
deaconesses, to give charitable service, but without
the name.2 The Mennonites, whose sect arose
in the early part of the sixteenth century, also
had church workers corresponding to the deacon-
esses. They were found throughout Holland,
and their example was later a great illumination
to the young pastor Fliedner.3 These women

1 Quoted by Schafer, op. tit., vol. i., p. 80.

2 The "Sister-houses" of this sect, like those of the order
under Gerhard Groote, did not correspond to the modern
deaconess houses, but were in part refuges or asylums for
the old and incapacitated members of the congregation,
and in part were sought by widows or girls without family
ties who desired the community life. Moreover, boarding
scholars were usually received from other places to be taught.
The direction of these houses was divided between two head
Sisters, one who had practical and another spiritual responsi-
bilities (after the pattern of Mary and Martha). Schafer,
vol. i, p. 292, quoting Herr D. H. Plitt in Niesky.

3 There are no definite sources for information regarding
the Mennonite deaconesses; their traces will be found scat-
tered here and there in books and records. But it is certain
that they were established from the beginning, and the books
of mart}rrs show that deaconess Elizabeth Dirks was im-

VOL. I. — 34.

53° A History of Nursing

lived in their own homes and their services were
voluntary. Then, it must not be forgotten that
the Sisters of Charity were distinctly apostolic,
and that St. Vincent de Paul explicitly reminded
them that they were as the women of the Early
Church.

In the decades immediately preceding the
Fliedners there was a great awakening of hu-
mane thought and an immense revival of as-
piration and enthusiasm for better conditions
and greater happiness for the human race, a
revival of which the French Revolution was the
mightiest outburst of expression. In the do-
main of such lines of thought as women were

prisoned in 1549 under the Inquisition and drowned. Robert
Browne, the father of the Brownist sect, who had known
a Mennonite community in Norwich, England, took from
them the idea of the deaconess, and thereafter the Brownists
always chose as deaconesses "Widows, 60 years old, zealous
for good works and able to nurse the sick." (Schafer, vol.
i., p. 290; quoting Prof. Dr. J. G. de Hoop-Scheffer of Amster-
dam). In Dordrecht in 1632 the records say that "honourable
elderly widows shall be chosen and ordained as deaconesses,
to assist the deacons among the poor, infirm, sick, feeble, and
afflicted," etc. (Schafer, vol. i., p. 290) "Also from among
the women were selected honourable, respectable matrons as
Elders (presbyteresses) who as housemothers in the house of
God had oversight of the widows, married women, and
maidens; reminded them of their duties, etc., etc. They also
visited the sick Sisters, comforted the sorrowing, etc. . . .
Many chose the single life, not with the motive of attaining
a higher grade of holiness, but to be able to devote themselves
better to nursing and the care of children. (Geschichte des
bibelgldubigen Ketzer, by Dr. C. U. Hahn, Stuttgart, 1847.
Quoted by Schafer, vol. i., p. 291.

The Pre-Fliedner Movements 531

most ungrudgingly allowed a share in, viz., char-
itable and humanitarian work, there was active
reciprocity between Germany and England, and
ardent spirits in one stimulated congenial minds
in the other. Hannah More's long life of steady
devotion to the cause of the poor, the needy, and
the uneducated was one of the first mile-stones
on the path of the re-emancipation of women from
the lives of ignorance and selfish futility in which
the dawn of the eighteenth century found them.
Her works were widely read in England and Ger-
many and created an enthusiasm in both countries.
The advanced and liberal ideas of the Society of
Friends favoured the unfolding of characters intent
on reforms, and prominent Dissenters, such as
John Wesley, accorded a widening sphere of
activity to women on evangelical lines, thus
indirectly stimulating the more conservative
circles of the Established Church to similar
expression.

The influence exerted upon hospital conditions
by John Howard's researches has been mentioned,
and presently we shall find that two notable
women, Amalia Siev eking in Germany and Eliza-
beth Fry in England, were, both by their own
efforts and by the share which each had in helping
to shape the career of pastor Fliedner, closely and
definitely related to the earliest movements of
nursing reform.

In searching for the various factors leading
up to the nursing reform work of the Fliedners

532 A History of Nursing

the share contributed by physicians of broad views
must not be overlooked. It is true that this
share consisted mainly in arousing their less ad-
vanced brethren, for, in the nature of the case,
medical men, though they might recognise the
evils of existing conditions, could do little or
nothing in the way of practically grappling with
the situation. They were unable to attract a
better personnel into hospitals or to grade and
discipline it properly. It was a part of this dis-
ability that not one, even those who were most
concerned and desirous of reform, ever perceived
the one and only practical solution of the prob-
lems which Miss Nightingale later set forth and
demonstrated. Nevertheless, in criticism, in for-
mulating principles and standards, and in agi-
tation, a distinguished group of the physicians
of that time did valuable and important work.
The Paris Academy in 1777 made a report upon
the appalling death-rate, which had first aroused
the medical faculty to a sense that something
was wrong, and this report exposed frightful con-
ditions in the hospitals and made many sug-
gestions for reform. 1 In Germany, toward the
close of the eighteenth century, medical pro-
fessors who were in teaching positions in the
universities began to agitate for nursing -reform.
Professor Carl Strack of Munich delivered a
public address in which he not only described the
mission of nursing as it should be, but. brought
home to the medical profession its responsibilities

The Pre-Fliedner Movements 535

and delinquencies and made the demand for a
better service. This gave a definite impulse to
many lines of improvement, and the condition
of hospital buildings and the comforts and sur-
roundings needed by the sick became subjects
of ever-increasing interest. Salzwedel says:

The wish to mitigate the sufferings of the sick was
the whole impulse of the nursing of the Middle Ages.
But now for the first time the idea that nursing was
one of the means of cure received consideration, for
hitherto drugs had been relied on entirely in the cure
of disease, with the exception of some few surgical
procedures. Now nursing came to be regarded as
as important as drugs.1

The French intellectuals had been spending
much thought on this subject for some time, for
an article written in 1764 says of nursing:

This occupation is as important for humanity
as its functions are low and repugnant. All persons
are not adapted to it, and heads of hospitals ought
to be difficult to please, for the lives of patients may
depend on their choice of applicants. The nurse
should be patient, mild, compassionate. She should
console the sick, foresee their needs, and relieve
their tedium. The domestic duties of the nurse are:
to light the fires in the wards and keep them going;
to carry and distribute nourishment; to accompany
the surgeons and doctors on their rounds and after-
wards to remove all dressings, etc. ; to sweep the halls,
and wards and keep the persons of the patients and

1 Handbuch der Krankcnpftege, p. 18.

534 A History of Nursing

their surroundings clean; to empty all vessels and
change the patients' linen; to prevent noise and
quarrelling and disturbances; to notify the steward
of everything they see which is wrong; to carry out
the dead and bury them; to light the lamps in the
evening and visit the sick during the night; and to
watch them continually, giving them every aid which
their state requires, and treating them with kindness
and consideration.1

Certainly an aggregation of duties which
few nurses would be capable of performing
satisfactorily.

Quite a number of nursing manuals appeared in
the dark period of nursing at the end of the eight-
eenth and in the beginning of the nineteenth
century. As early as the year 1709 a text-book
translated from the French was published in Vi-
enna, and a later edition was printed at Lausanne
in 1788. 2 In 1728 a Spanish manual was pub-
lished in Madrid for the nurses of the general hos-
pital there.3 A German manual was published
in 1769,* and another in I784.5 A later French

^ LEncy do pe die de Diderot ct d'Alembert, Art. " Infirmier."
Published by Murray.

/ nterricht fiir Personen u'dchc die K'aiikr warten. Ans
dan Franzosischen ubersetzt, Wim, 1709. Instruction pour
les -personnes qui gardent Ics ma lades. Lausanne, 1788.

3 Instruction dc enfermeros y mode aplicar los remedies, etc.,
Compitcsto por los hijos de la congregation del venerabilc
Padre Bernardino de Obregon. Madrid, 1728.

4 Von dcr Wartnng dcr Kranken. Unzer, 1769.

5 U nterricht fiir Krankenwdrter. Franz May, Mannheim*
1784.

The Pre-Fliedner Movements 535

edition appeared in 1787,* and another written
in German by a professor at Moscow in 1793 .2 Not
all of these old books are easily found ; but two now
in the Royal Library at Berlin and in the Surgeon-
General's library at Washington a,re deserving
of notice. They are Dr. May's and Dr. Pfahler's.
The latter is truly scientific in its spirit, and is
written with admirable lucidity and simplicity.
It seems as if the most obtuse intellect could
obtain some enlightenment from it. In its clear,
definite details, of which not the smallest or the
most ordinary is overlooked, it bears comparison
as to simplicity of style \vith Miss Nightingale's
incomparable Notes. The qualities of the
ideal nurse, as he describes them, are beyond
criticism ; but, as he prefaced his remarks by the
statement that she must not be a thief or a
drunkard, it is probable that he never met his
ideal in the flesh. His directions for the arrange-
ment and care of the bedroom, the necessity for
written reports and directions as to how to keep
them, the procedure in all the various treatments,
and the use of appliances, — all is in accord with
the most fastidious modern ideas. He empha-
sises the psychical side of nursing, and depicts
most impressively the ill effects on the patient
of anger, irritation, sadness, and melancholy.

1 Manuel -pour les Gardes-Malades. Carrere, Strasburg,
1787.

2 Unterricht fur Personen welche Kranke warten. J. G.
Pfahler, Riga, 179^.

536 A History of Nursing

Dr. May's book is also interesting and practical,
but generalises more as to principles and does
not give so many minute details. A nurse would
not learn so much from it as from the other, but
a very unusual and commendable feature is that
May makes a plea for good treatment for the
nurses. He recognises the fact that they are too
often treated as slaves or as lazy day-labourers,
and that such treatment must necessarily render
them embittered, and claims that the best results
are to be gained by arousing the interest of the
nurse and engaging his or her loyal co-operation.
He further gives directions to nurses for pre-
serving their own health. Besides medical and
surgical nursing he treats of obstetrical work and
gives diet lists suitable for different diseases and
surprisingly like those of to-day. Both of these
excellent text-books deprecate the tendency of
nurses to become quacks, and their proneness to
superstition.

These two wrorks on nursing were widely read
by the medical fraternity and made a great im-
pression. Dr. May himself established a course
of instruction for hospital attendants in Mann-
heim (rather too enthusiastically referred to by
German historians of nursing as a "School"), and
other hospital chiefs followed his example in
Carlsruhe, Heidelberg, and Lucerne. But as
they did not bring fresher or finer material into
the service, or remodel the system under which
nursing was carried on, and as they finally could,

The Pre-Fliedner Movements 537

in fact, only lecture to, but could not practically
teach the attendants methods of work beyond
certain treatments and fixed procedures, it is
incorrect to think of these pioneer attempts as
equivalent to the establishment of schools of
nursing. They supplied courses of theoretical
instruction, where the principles of nursing but
not nursing itself could be learned. As Salzwedel
speaks of "manifold opposition" to Dr. May's
undertaking it is evident that even this most
elementary teaching was in its day thought to be a
dangerous innovation.

No more attractive and admirable medical
chiefs than these two scholarly professors are
mentioned in history. Their genial characters
and ability to appreciate the best work are clearly
attested in their writings, and their interest in and
efforts for a better nursing order ought never to
be forgotten.

At the end of the eighteenth century, by the
action of the medical faculty of Magdeburg, in
Prussia, an institution for the instruction of male
nurses was established in that city and placed,
oddly enough, under the management of the
director of the Midwives' Institute.1 A similar
plan was projected for the Charite in Berlin in
1800, but no suitable male applicants offered
themselves. In 1812 an institute for teaching
the attendants in hospitals was founded in Vienna

i From the Konigl. Preussische Medicinal-Verfassung, Pots-
dam, 1818.

538 A History of Nursing

by the Austrian government, and affiliated with the
University through the efforts of one of the profes-
sors of the faculty under whose charge it was
placed. Strasburg made a similar official attempt
in 1814. l

Immediately preceding the new era a nursing
manual was published by Dr. Dieffenbach, a
celebrated surgeon of the Charite Hospital.2
This book shows a great advance in appliances
and treatment and a much more elaborate mode
of procedure, but is not as good a nursing manual
as the two older books mentioned, and far behind
the teaching of the Greek physicians of two thou-
sand years earlier as regards bathing and fresh
air. It shows plainly what a wretched standard
of nursing was found in the hospitals, and inci-
dentally throws light on some of the reasons for
this inferiority. A dread of fresh air is openly
taught in this treatise. The windows were to be
opened only with the greatest precautions, once
in the morning and once in the afternoon, except
in summer, when they might be open all day if
the weather were not too hot. They were never to
be opened in the evening or night air, because this
was even more dangerous than draughts. Venti-
lation must come from the next room, where the
windows might at intervals be opened, or from
openings in the wall. Following this come many

1 Salzwedel, Handbuch der Krankenpftege, p. 18.

2 Anleitung zur Krankenwartung : Dr. Z. F. Dieffenbach,
Berlin, 1832.

The Pre-Fliedner Movements 539

directions for deodorising the sick-room. After
stating that no smell at all is best for a sick-room,
the author recognises the fact there are always
so many bad smells that it is best to counteract
them by burning vinegar or herbs or lime in the
room. Bathing a patient in bed seems to have
been an unknown art. A bath meant a tub,
and patients who could not get up were to have
their hands and faces washed, and their mouths
rinsed. The directions to the nurse for pre-
paring for a major operation occupy one small
page. Many procedures are described in a way
suitable only for medical students, and the writer
evidently had no conception of how to teach
nurses. He has filled pages with bitter com-
plaints of the good-for-nothings who are in hos-
pital service, their ignorance, neglect of orders,
and general unreliability, and pours especial
scorn on "old women,' of whom he cannot say
enough that is crushing. (It is significant that
all these writers use, not the word "nurse," but
"attendant.") It was through the efforts of Dr.
Dieffenbach that the most important secular
school for attendants (it was not called a school of
nursing) in Germany was opened in 1832, at the
Charite Hospital. This attempt to improve the
"attendants," both men and women (Warier and
Wdrterinnen), prescribed a two or three months'
course of study, given by the physicians, after
which a certificate was accorded. As there was an
old Prussian law relating to the bestowal of these

540 A History of Nursing

certificates or testimonials, this may be looked
upon as the earliest example, in modern states at
least, of the recognition of a legal status for nurses. 1
But, in view of the facts that there was no oversight
except by the lay under-officials (all men — stew-
ards, clerks, etc.) who delighted in bullying
the nurses; that there was no woman head to
protect them, and no plan of practical teaching
in handling the patient; that the sleeping accom-
modations were miserable, the food was poor, the
hours of work were inhuman, the pay was small,
and there was no opportunity for advancement,
these lay courses in state hospitals utterly failed
to attract a superior class either of men or women,
whereas the schools of the deaconesses, now about
to open, succeeded in drawing hundreds into their
service.

The primary stimulus to the nursing reform
work of the nineteenth century was the object
lesson given by the splendid activity of the women
of Germany in the \Var of Freedom, ' or Na-
poleonic war of 1813. The work of the women's
societies formed at this time for relief, for nursing,
and for helping the families of the soldiers, so im-
pressed a young pastor of Bislich, Johann Klonne,
that he wrote in 1820, in pamphlet form, an
earnest appeal entitled, "A Plea for the Revival

1 Besides the interne students, a class of externes was also
admitted to lectures on payment of a small fee, and such
externes usually stood in line for vacancies occurring in the
ward staffs.

The Pre-Fliedner Movements 54*

of the Ancient Deaconesses in our Women's
Societies." He was enthusiastic over the possi-
bilities that he saw in the utilisation of this force
for the service of the Church and tried hard to gain
support for his ideas. He sent his pamphlet to
the prime minister of Prussia, and to the Princess
Marianne, who had taken an active and prominent
part in the women's societies in war times. He
also took it to Bishop Eylert in 1824, but, although
he met with sympathy, he found no one to carry
out his ideas. The Princess Marianne thought
free or voluntary work more promising than
communistic labours, and also thought it would
be impossible to combine the work of a deaconess
with marriage. Pastor Klonne was extremely
impractical in his ideas for carrying out his views.
He had no notion of the importance of training,
nor did he plan for a life calling, but thought that
the women of the parish could take turns in
conducting children's homes, nursing in hospi-
tals, etc. Baron Von Stein, in writing of pastor
Klonne's proposal, said:

In visiting the institutions of the Sisters of Charity
I was exceedingly struck by the expression of inward
peace, repose, self-denial, and innocent sprightliness
of the Sisters and by their kind and benign treatment
of the sick intrusted to their care. To such sights
a pitiful contrast is offered by the expression of dis-
content, in young women of the upper and middle
classes not obliged to earn their bread by the work
of their hands, fretted by ungratified vanity, mortified

542 A History of Nursing

by neglect, who on account of pretensions, disregarded
in a thousand forms, and on account of their idleness,
are conscious of an emptiness and bitterness in their
lives which make them unhappy themselves and
burdensome to others.

Nothing came of Klonne's writings, and the next
attempt — made by Count Adelbert von der Recke
Vollmerstein,1 — was no more successful. In 1835,
he wrote: "Twenty years ago I felt the need of
deaconesses in our church, and spoke of it fre-
quently.' In the same year (1835) ne started
a periodical called The Deaconess, or Life and
Work of the Handmaidens of the Church in
Doctrine, Education, and Nursing. Only one
issue appeared, and it seems not unlikely that its
title may have killed it, even though that was the
day of long titles. His ideas tended to an excess
as much as those of Klonne did to a lack of
organisation. His plan was strictly churchly, and
provided for abbesses, archdeaconesses, and dea-
conesses.

1 Count von der Recke, who had established a reformatory
for girls, actually made a beginning in the deaconess move-
ment. A report written by him in a Dusseldorf paper in
1835 ran as follows: "We could not resist the wish to estab-
lish a deaconess in our reformatory and to call this most
important activity into being here according to our cherished
plans. The first deaconess who undertook our work was
endowed with worldly goods and a wealth of loving zeal."
Following her came three others, but a serious illness pros-
trated Count von der Recke, and put an end to his work.
Later, with the opening of Kaiserswerth, he felt that the
work was in the best hands. (Schafer, vol. i., p. 299, from
private sources.)

The Pre-Fliedner Movements 543

An evangelical hospital that supplied a train-
ing for nurses was actually started before the
institution at Kaiserswerth, although it had no
deaconesses. Johannes Gossner, pastor of a con-
gregation in Berlin, in connection with several
friends, had founded a Woman's Society for
Nursing the Sick in 1833, having previously es-
tablished a similar society for men. Finding that
they needed a hospital in the care of their sick,
they had rented a house for this purpose on July
9, 1836. Later a proper hospital was built and
named after Queen Elizabeth of Prussia. This
society did nursing in the hospital and in private
houses; the services were all entirely free, and
soup was provided for from ten to fifteen thou-
sand patients annually. Pastor Gossner1 was not
in favour of the title "deaconess,' but preferred
the word "Pflegerin' (nurse). His training was
after the pattern of that of the Sisters of Mercy,
and he wrote a tract entitled How Must Christian
Nurses or Evangelical Sisters of Mercy be Con-
stituted ? His nurses wore a uniform, but the
organisation was not stable, and after his death

1 Gossner was a man of noble character, and some of his
friends who loved him warmly contended that he and not
Fliedner was the founder of the revived order of deaconesses,
since he sent instrvicted nurses from the year 1835 into homes
in Berlin and at a distance ; that he could not develop his
work very far, principally because he was not married,, but
that his ideas and conceptions were complete. The name
deaconess, however, he disliked. Schafer, vol. i., p. 307,
quoting from local periodicals.

544 A History of Nursing

a Motherhouse for deaconesses was established
in the Elizabeth Hospital.1

In the life and work of that remarkable woman
Amalie Sieveking we now meet one of the most
vigorous and sensible characters of her time.
Born in Hamburg in 1794, of good family, well
endowed with fortune, and highly educated,
in her social circle Amalie Sieveking met all the
intellectual people of the day, and thought and
talked on all subjects imaginable. Even as a
young girl she showed remarkable talent and
energy in practical friendliness and altruism,
and a marked power of influencing others. Her-
self only a girl she began teaching other young
girls gratuitously for the pure love of it, and this
occupation she continued throughout an exceed-
ingly busy life. One of these pupils later enters
prominently into our story. Amalie had a strong
sense of humour, marked common-sense, shrewd-
ness, and an unbounded courage in her opinions
and actions. She was early stirred by reading
a book called Counsels of the Rev. Camp to his
Daughters, which excited her strongest dissent,
and she rebelled against the doctrine that mar-
riage was the only destiny of woman. She wrote,
in her young womanhood, two books of Commen-
taries on the Bible, for which she was regarded
with deep disapproval by all conservative per-
sons, and in her letters she describes in a very

1 Golder, op. cit., pp. 83-84.

The Pre-Fliedner Movements 545

lively arid caustic style the severe snubs she
received on this account from theologians. She
conceived an earnest desire to found an order of
Protestant Sisters of Charity and to join it herself,
and this wish dominated her mind for many
years. She was strongly and genuinely pious
and abhorred all shams and superficial conven-
tionalities. Her first real public work was done
in 1831, when, during an epidemic of cholera in
Hamburg, she offered to serve in the pest-hospital.
Her mother, her only living relative, was quite
willing she should do this, but all of her friends
thought it shocking; a "pose" for martyrdom,
immodest, or in bad taste. In spite of these
criticisms she went to the hospital and worked
there for about two months, until the scourge
subsided. Her letters from the hospital to her
mother give an animated but most practical and
sensible account of her experiences. There were
only servant-nurses to help her, and she worked
day and night, having at first charge of the wo-
men's wards, but soon after, at the doctor's
request, assuming the oversight of the men's
wards also. At first she was a little afraid that
the personnel in the men's wards might not be
willing to obey her, but the doctors reassured her,
and gave the strictest orders that she was to be
obeyed implicitly. She writes in a letter to her
mother :

My work is varied and I cannot tell you all in de-
tail. As to the night watching, I share it with the two

VOL. I. — 35.

546 A History of Nursing

nurses and am but little wearied. If necessary I
sleep for some time during the day, which is safer than
neglecting the watch at night, or the rounds, which,
as supervisor of the men's wards, I must make every
two hours. In the morning I must see that all is in
order for the doctors' visits; beds made, wards clean,
etc. Three times a day with the physician, surgeon,
and pharmacist I visit each patient. The doctor
gives his orders — I must note especially those which
concern the women. For the men I note what is
ordered for nourishment and drink, and give the
lists to the steward; moreover, I am responsible for
written reports, the linen etc.

The physicians, who received her at first with
doubt, though not with opposition, were soon
grateful and appreciative. By her simple direct-
ness and tactfulness she avoided all possible
friction with underlings, and went away beloved
by all, the medical staff assembling upon her de-
parture to read aloud a testimonial of admiration.
This hospital experience led her to develop a plan
for founding a society called The Friends of the
Poor," and this she proceeded to execute with
energy, sound practical sense, and a thorough
knowledge of human nature. Her purpose was
that certain ladies should undertake a systematic
visiting of poor families where there was sickness
or distress, at least once a week or oftener, to
help them in all ways, with the exception that no
money was to be given outright. She found it
hard to get the right kind of women. Those of

The Pre-Fliedner Movements 547

her own class held back and she tried middle-
class women, but of her experience she says:
"I thought at first that they would understand
better the needs of the poor, but I am now certain
that a wider culture contributes much to solidity
of judgment. ' She also says :

A difficult point at first was the relation to the
physicians. We had to depend on them to send us
cases. Several promised to do so. One refused on
the ground that our work would destroy the one good
and fine thing left, which was the kindness showed
by the poor to each other. Later he sent cases, but
was made angry by one of the visitors having advised
a homeopathic remedy to one.of the patients ; however,
I promised him this should not happen again.

Another little tale she tells thus :

We were visiting a man who was nearly well, and I
loaned him some books. The wife was also ill and had
a nurse who presently told us that Dr. R. had con-
fiscated the husband's books. I went to see the
doctor and saw the books on his table, but talked about
other things. Presently he said "What sort of books
have you given those people?' "The books were
for the convalescent, do you think they would hurt
him?" "I have not read them, but I mistrust those
blue pamphlets. They are all worthless." Presently
he began recommending to me a most stupid book,
Moral Doctrine, and I promised to carry it to the
patient, preferring to yield on this point ar d have
my hands free in a hundred others.

She carried on this work for the rest of her

548 A History of Nursing

life with untiring energy and ability. It ex-
tended, and the physicians all became its friends.
The members of the society provided nourishment,
appliances, chairs, beds, etc., in case of illness;
found employment for the wage-earners, often
providing employment for one in a needy family
by service in another equally needy, — washing,
helping, etc. They looked up new kinds of work,
for disabled persons: thus a carpenter, who had
lost the use of his left arm from an abscess, was
taught rope-slipper making, at which he became
an adept and earned his living. Children with
chronic diseases were taught and entertained, and
as a development a children's hospital was built.
Chronic patients were taken to drive and to
church, read aloud to, etc. It was a real
'Friendly Visiting' in a most practical way and
from the point of helping the people to help them-
selves. This work absorbed her so that when
pastor Fliedner first approached her, as he did
at Christmas 1836, to ask her to take charge of the
Kaiserswerth deaconess house, then just founded,
she refused. The pastor's first wife was tem-
porarily in charge. At this time, moreover,
Amalie was busy with plans for improved dwel-
lings for the poor. About 1839 she was offered the
post of head of the women's department in the
great City Hospital of Hamburg. This also she
declined, but placed there Caroline Bertheau, who
had been one of her dearest pupils, and who after-
wards became Fliedner 's second wife. Her housing

The Pre-Fliedner Movements 549

plans were worked out in a group of dwellings
around an infirmary, called after her the Amalien-
stift. When, some years later, Fliedner came a
second time to ask her to take charge of the new
deaconess house in Berlin, she directed him to
Caroline, who was still nursing in the hospital,
and who, instead of accepting the position became
his wife. The rest of Amalie's life was spent in
perfecting the details of her various undertakings,
her teaching, and in an extensive and unbroken
correspondence and relationship with prominent
philanthropists in Germany and the neighbouring
countries, to whom her work was an inspiration.
She died in 1859.

i Denkwiirdigkeiten aus dent Leben von Amalie Sieveking,
Hamburg, 1860. Authentic Memories with extracts from
her diary and letters, by one of her friends, with a preface
by Dr. Wichern.

END OF VOLUME I,

CENTRAL RESERVE
STH fAVE, & 42ND ST., ROOM 1OO

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Full text of "A history of nursing; the evolution of nursing systems from the earliest times to the foundation of the first English and American training schools for nurses"

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